Provider First Line Business Practice Location Address:
1624 W DEAN AVE
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:
99201-1825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-939-0719
Provider Business Practice Location Address Fax Number:
509-464-6463
Provider Enumeration Date:
02/12/2015