Provider First Line Business Practice Location Address:
1515 E 39TH 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:
99203-4129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-951-2052
Provider Business Practice Location Address Fax Number:
590-747-7006
Provider Enumeration Date:
03/18/2014