Provider First Line Business Practice Location Address:
10121 N NEVADA ST
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99218-3120
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-466-6979
Provider Business Practice Location Address Fax Number:
509-466-0731
Provider Enumeration Date:
01/03/2012