Provider First Line Business Practice Location Address:
21 S THIERMAN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99212-5063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-534-4084
Provider Business Practice Location Address Fax Number:
509-534-4084
Provider Enumeration Date:
09/23/2010