Provider First Line Business Practice Location Address:
4750 N DIVISION ST
Provider Second Line Business Practice Location Address:
SUITE 214
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99207-1411
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-863-9167
Provider Business Practice Location Address Fax Number:
509-413-1931
Provider Enumeration Date:
04/19/2010