Provider First Line Business Practice Location Address:
5322 N DIVISION ST
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99207-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-795-0271
Provider Business Practice Location Address Fax Number:
509-357-5060
Provider Enumeration Date:
02/27/2012