Provider First Line Business Practice Location Address:
105 WEST 8TH AVE
Provider Second Line Business Practice Location Address:
STE 408
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2318
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-455-8660
Provider Business Practice Location Address Fax Number:
509-455-8662
Provider Enumeration Date:
01/30/2007