Provider First Line Business Practice Location Address:
4305 EAST TRENT AVENUE
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
97-953-1335
Provider Business Practice Location Address Fax Number:
509-795-3141
Provider Enumeration Date:
12/05/2011