Provider First Line Business Practice Location Address:
1027 E QUEEN 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:
99207-3365
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-219-7237
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/27/2009