Provider First Line Business Practice Location Address:
1402 N DIVISION ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202-1811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-327-7078
Provider Business Practice Location Address Fax Number:
509-327-3404
Provider Enumeration Date:
05/04/2017