Provider First Line Business Practice Location Address: 
212 E CENTRAL AVE STE 245
    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: 
99208-6289
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
509-489-2600
    Provider Business Practice Location Address Fax Number: 
509-227-7070
    Provider Enumeration Date: 
04/13/2015