Provider First Line Business Practice Location Address:
9212 N COLTON ST
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:
99218-1284
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-464-2736
Provider Business Practice Location Address Fax Number:
509-464-4692
Provider Enumeration Date:
09/29/2015