Provider First Line Business Practice Location Address:
1128 W 18TH 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:
99203-1115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-998-5575
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2009