Provider First Line Business Practice Location Address:
1623 W GARDNER 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:
99201-1830
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-328-6274
Provider Business Practice Location Address Fax Number:
509-326-2341
Provider Enumeration Date:
12/06/2006