Provider First Line Business Practice Location Address:
1005 PINES RD N
Provider Second Line Business Practice Location Address:
STE 250
Provider Business Practice Location Address City Name:
SPOKANE VLY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-4993
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-927-1194
Provider Business Practice Location Address Fax Number:
509-927-8819
Provider Enumeration Date:
09/28/2007