Provider First Line Business Practice Location Address:
1125 S CEDAR ST
Provider Second Line Business Practice Location Address:
APT 6
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-4066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-599-9902
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/04/2009