Provider First Line Business Practice Location Address:
15319 E INDIANA AVE
Provider Second Line Business Practice Location Address:
SUITE 3
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1863
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-252-0633
Provider Business Practice Location Address Fax Number:
509-928-7832
Provider Enumeration Date:
12/03/2009