Provider First Line Business Practice Location Address:
1227 W SUMMIT PKWY STE A
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:
99201-7003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-990-3054
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/18/2012