Provider First Line Business Practice Location Address:
418 E 30TH AVE STE 2
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:
99203-2581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-624-1139
Provider Business Practice Location Address Fax Number:
509-624-4617
Provider Enumeration Date:
03/23/2015