Provider First Line Business Practice Location Address:
1414 N HOUK RD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-473-5494
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/19/2006