Provider First Line Business Practice Location Address:
6021 N LIDGERWOOD 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:
99208-1125
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-489-3323
Provider Business Practice Location Address Fax Number:
509-483-7169
Provider Enumeration Date:
11/13/2006