Provider First Line Business Practice Location Address:
12509 E MISSION AVE
Provider Second Line Business Practice Location Address:
STE. 202
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-444-5678
Provider Business Practice Location Address Fax Number:
509-343-5678
Provider Enumeration Date:
09/24/2008