Provider First Line Business Practice Location Address:
400 S JEFFERSON ST STE 163
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:
99204-3143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-456-5733
Provider Business Practice Location Address Fax Number:
509-327-5191
Provider Enumeration Date:
05/14/2009