Provider First Line Business Practice Location Address:
2507 E 27TH AVE
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:
99223-4908
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-456-6917
Provider Business Practice Location Address Fax Number:
509-456-5902
Provider Enumeration Date:
02/05/2007