Provider First Line Business Practice Location Address:
817 S PERRY ST UNIT B
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:
99202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-444-8888
Provider Business Practice Location Address Fax Number:
509-444-7806
Provider Enumeration Date:
10/25/2015