Provider First Line Business Practice Location Address:
1016 N SUPERIOR ST
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:
99202-2059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-483-6495
Provider Business Practice Location Address Fax Number:
509-483-1541
Provider Enumeration Date:
06/21/2005