Provider First Line Business Practice Location Address:
3754 W INDIAN TRAIL RD
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:
99208-4736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-328-7041
Provider Business Practice Location Address Fax Number:
509-328-7582
Provider Enumeration Date:
03/30/2016