Provider First Line Business Practice Location Address:
12016 E SPRAGUE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-5145
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-995-4308
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2011