Provider First Line Business Practice Location Address:
9211 E MISSION AVE STE G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-4096
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-921-0453
Provider Business Practice Location Address Fax Number:
509-323-9255
Provider Enumeration Date:
03/13/2008