Provider First Line Business Practice Location Address:
5625 N WALL ST
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:
99205-6435
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-482-1982
Provider Business Practice Location Address Fax Number:
509-482-1983
Provider Enumeration Date:
04/16/2007