Provider First Line Business Practice Location Address:
501 S BERNARD ST
Provider Second Line Business Practice Location Address:
203
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-952-2169
Provider Business Practice Location Address Fax Number:
503-952-2269
Provider Enumeration Date:
07/16/2013