Provider First Line Business Practice Location Address:
1521 E ILLINOIS AVE STE 107
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:
99207-5147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-217-5529
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/28/2019