Provider First Line Business Practice Location Address:
3711 W WOODSIDE AVE
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:
99208-4860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-990-9416
Provider Business Practice Location Address Fax Number:
509-919-4877
Provider Enumeration Date:
10/16/2007