Provider First Line Business Practice Location Address:
9001 N COUNTRY HOMES BLVD
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:
99218-2072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
833-411-5469
Provider Business Practice Location Address Fax Number:
855-459-3020
Provider Enumeration Date:
10/22/2007