Provider First Line Business Practice Location Address:
9720 N NEVADA ST
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:
99218-3412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-464-2273
Provider Business Practice Location Address Fax Number:
509-242-1854
Provider Enumeration Date:
08/26/2015