Provider First Line Business Practice Location Address:
1303 S GRAND 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:
99202-1136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-474-0213
Provider Business Practice Location Address Fax Number:
509-315-8354
Provider Enumeration Date:
11/25/2009