Provider First Line Business Practice Location Address:
405 E HARTSON AVE
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202-1343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-624-0264
Provider Business Practice Location Address Fax Number:
509-624-0280
Provider Enumeration Date:
10/03/2009