Provider First Line Business Practice Location Address:
15920 E INDIANA AVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-6011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-321-5662
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2009