Provider First Line Business Practice Location Address:
1923 N LOCUST RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VLY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-4149
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-953-3692
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2012