Provider First Line Business Practice Location Address:
731 W. INDIANA 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:
99205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-325-2051
Provider Business Practice Location Address Fax Number:
509-325-2136
Provider Enumeration Date:
12/05/2006