Provider First Line Business Practice Location Address:
2204 E 29TH AVE
Provider Second Line Business Practice Location Address:
STE. 208
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99203-3961
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-535-9515
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/23/2005