Provider First Line Business Practice Location Address:
12211 E BROADWAY AVE
Provider Second Line Business Practice Location Address:
STE 3
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-6132
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-928-3164
Provider Business Practice Location Address Fax Number:
509-834-7667
Provider Enumeration Date:
11/07/2011