Provider First Line Business Practice Location Address:
1120 N. PINES
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-4942
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-768-4248
Provider Business Practice Location Address Fax Number:
509-343-0504
Provider Enumeration Date:
10/24/2005