Provider First Line Business Practice Location Address:
316 W BOONE AVE
Provider Second Line Business Practice Location Address:
STE 656
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-2346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-606-3997
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/07/2006