Provider First Line Business Practice Location Address:
17 E EMPIRE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99207-1707
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-328-3430
Provider Business Practice Location Address Fax Number:
509-328-6178
Provider Enumeration Date:
03/17/2006