Provider First Line Business Practice Location Address:
4924 N ELGIN 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:
99205-5642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-251-0191
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/28/2013