Provider First Line Business Practice Location Address:
1303 W MAXWELL 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:
99201-2714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-979-7922
Provider Business Practice Location Address Fax Number:
509-747-3828
Provider Enumeration Date:
10/12/2006