Provider First Line Business Practice Location Address:
212 E WEDGEWOOD AVE
Provider Second Line Business Practice Location Address:
APT#47
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208-5385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-879-9598
Provider Business Practice Location Address Fax Number:
509-325-0491
Provider Enumeration Date:
07/26/2007