Provider First Line Business Practice Location Address:
511 S PINE STREET
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202-1347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-325-9144
Provider Business Practice Location Address Fax Number:
509-325-0422
Provider Enumeration Date:
03/22/2006