Provider First Line Business Practice Location Address:
1411 E MISSION AVE
Provider Second Line Business Practice Location Address:
MSC-9
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202-1902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-495-4368
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/27/2014