Provider First Line Business Practice Location Address:
511 S PINE ST
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202-1347
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-747-5242
Provider Business Practice Location Address Fax Number:
509-747-5430
Provider Enumeration Date:
06/08/2007