Provider First Line Business Practice Location Address:
12519 N DIVISION ST STE 4
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:
99218-1936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-795-1690
Provider Business Practice Location Address Fax Number:
509-356-9418
Provider Enumeration Date:
01/14/2008