Provider First Line Business Practice Location Address:
546 N JEFFERSON LN
Provider Second Line Business Practice Location Address:
STE 200
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-7103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-688-6700
Provider Business Practice Location Address Fax Number:
509-455-6913
Provider Enumeration Date:
09/23/2014