Provider First Line Business Practice Location Address:
1327 W NORTHWEST BLVD
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:
99205-4315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-327-1504
Provider Business Practice Location Address Fax Number:
509-327-1505
Provider Enumeration Date:
02/29/2008