Provider First Line Business Practice Location Address:
12704 E NORA AVE
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-928-9415
Provider Business Practice Location Address Fax Number:
509-928-9127
Provider Enumeration Date:
07/19/2012