Provider First Line Business Practice Location Address:
5503 N WALL ST STE A
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:
99205-6402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-489-2020
Provider Business Practice Location Address Fax Number:
509-489-3387
Provider Enumeration Date:
11/22/2014