Provider First Line Business Practice Location Address:
323 W FIFTEETH 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:
99203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-981-0355
Provider Business Practice Location Address Fax Number:
509-838-0002
Provider Enumeration Date:
03/06/2007