Provider First Line Business Practice Location Address:
1212 N WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-2403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-475-5691
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2017