Provider First Line Business Practice Location Address:
509 N SULLIVAN RD 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:
99037-8566
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-922-2400
Provider Business Practice Location Address Fax Number:
509-922-1577
Provider Enumeration Date:
05/29/2007