Provider First Line Business Practice Location Address:
1717 W NORTHWEST BLVD
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:
99205-3601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-325-0777
Provider Business Practice Location Address Fax Number:
509-325-3464
Provider Enumeration Date:
12/19/2010