Provider First Line Business Practice Location Address:
101 W CASCADE WAY
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-468-1535
Provider Business Practice Location Address Fax Number:
509-467-6372
Provider Enumeration Date:
10/25/2005