Provider First Line Business Practice Location Address:
10103 N DIVISION ST STE 103
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:
99218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-624-3561
Provider Business Practice Location Address Fax Number:
509-443-5447
Provider Enumeration Date:
11/16/2006