Provider First Line Business Practice Location Address:
1911 W CLEVELAND 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:
99205-3631
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-489-5140
Provider Business Practice Location Address Fax Number:
509-489-5140
Provider Enumeration Date:
01/31/2010