Provider First Line Business Practice Location Address:
801 W 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 504
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-838-2531
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2006