Provider First Line Business Practice Location Address:
2910 E 57TH AVE
Provider Second Line Business Practice Location Address:
STE 5-198
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99223-7028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-994-7163
Provider Business Practice Location Address Fax Number:
509-443-2306
Provider Enumeration Date:
06/12/2007