Provider First Line Business Practice Location Address:
10003 N DIVISION ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99218-1344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-468-2102
Provider Business Practice Location Address Fax Number:
509-468-2108
Provider Enumeration Date:
08/03/2005