Provider First Line Business Practice Location Address:
13607 EAST SPRAQUE AVENUE
Provider Second Line Business Practice Location Address:
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-202-5260
Provider Business Practice Location Address Fax Number:
509-931-0780
Provider Enumeration Date:
11/09/2017