Provider First Line Business Practice Location Address:
12209 E MISSION AVE
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-4824
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-465-5522
Provider Business Practice Location Address Fax Number:
614-386-0278
Provider Enumeration Date:
06/08/2008