Provider First Line Business Practice Location Address:
3009 S MOUNT VERNON ST STE 2
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:
99223-4777
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-535-7434
Provider Business Practice Location Address Fax Number:
509-536-4744
Provider Enumeration Date:
06/29/2017