Provider First Line Business Practice Location Address:
7411 NORTH NEVADA STREET
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:
99208-5518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-489-2273
Provider Business Practice Location Address Fax Number:
509-482-3041
Provider Enumeration Date:
09/13/2005