Provider First Line Business Practice Location Address:
12615 E MISSION AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1047
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-928-4442
Provider Business Practice Location Address Fax Number:
509-928-4447
Provider Enumeration Date:
02/23/2006