Provider First Line Business Practice Location Address:
6404 S LATAH HILLS CT
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:
99224-8530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-481-0487
Provider Business Practice Location Address Fax Number:
509-228-9542
Provider Enumeration Date:
11/27/2006