Provider First Line Business Practice Location Address:
1220 W SPRAGUE 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:
99201-4112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-879-8329
Provider Business Practice Location Address Fax Number:
509-456-5336
Provider Enumeration Date:
06/13/2007