Provider First Line Business Practice Location Address:
104 S FREYA ST
Provider Second Line Business Practice Location Address:
GREEN FLAG BLDG. SUITE 110A
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202-4862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-850-0528
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/13/2015