Provider First Line Business Practice Location Address:
2136 W RIVERSIDE AVE
Provider Second Line Business Practice Location Address:
APT 101
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-1444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-263-5690
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2014