Provider First Line Business Practice Location Address:
2204 E 29TH AVE
Provider Second Line Business Practice Location Address:
SUITE #104
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99203-3961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-321-1404
Provider Business Practice Location Address Fax Number:
509-321-0211
Provider Enumeration Date:
06/26/2008