Provider First Line Business Practice Location Address:
905 WEST RIVERSIDE AVENUE
Provider Second Line Business Practice Location Address:
SUITE 610
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-1099
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-742-3460
Provider Business Practice Location Address Fax Number:
509-742-3461
Provider Enumeration Date:
10/04/2006