Provider First Line Business Practice Location Address:
546 N JEFFERSON LN
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:
99201-7104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-624-0111
Provider Business Practice Location Address Fax Number:
509-227-7070
Provider Enumeration Date:
07/14/2006