Provider First Line Business Practice Location Address:
1427 W NORTHWEST BLVD
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:
99205-4346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-413-2856
Provider Business Practice Location Address Fax Number:
509-413-2856
Provider Enumeration Date:
11/09/2005