Provider First Line Business Practice Location Address:
3143 E 29TH 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:
99223-4815
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
702-631-3530
Provider Business Practice Location Address Fax Number:
702-631-3529
Provider Enumeration Date:
02/21/2007