Provider First Line Business Practice Location Address:
2028 E 18TH AVE
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:
99203-3749
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
555-555-1212
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/08/2009