Provider First Line Business Practice Location Address:
123 EAST INDIANA
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:
99207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-326-2142
Provider Business Practice Location Address Fax Number:
509-326-4926
Provider Enumeration Date:
09/16/2005