Provider First Line Business Practice Location Address:
8818 E GRACE 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:
99212-2165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-927-1138
Provider Business Practice Location Address Fax Number:
509-921-5259
Provider Enumeration Date:
11/28/2012