Provider First Line Business Practice Location Address:
205 W INDIANA AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99205-4763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-326-6474
Provider Business Practice Location Address Fax Number:
509-326-2565
Provider Enumeration Date:
04/29/2006