Provider First Line Business Practice Location Address:
104 S FREYA STREET
Provider Second Line Business Practice Location Address:
GREEN FLAG BLDG., SUITE 111B
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:
509-599-1093
Provider Business Practice Location Address Fax Number:
509-931-0475
Provider Enumeration Date:
01/18/2016