Provider First Line Business Practice Location Address:
6821 N COUNTRY HOMES BLVD STE 101
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:
99208-4373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-344-2020
Provider Business Practice Location Address Fax Number:
509-344-2021
Provider Enumeration Date:
03/26/2007