Provider First Line Business Practice Location Address:
5615 W SUNSET HWY
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:
99224-9454
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-901-6117
Provider Business Practice Location Address Fax Number:
206-901-6108
Provider Enumeration Date:
02/16/2007