Provider First Line Business Practice Location Address:
1101 W COLLEGE 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:
99201-2095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-324-1613
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2017