Provider First Line Business Practice Location Address:
13007 E MISSON 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:
99216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-922-6552
Provider Business Practice Location Address Fax Number:
509-891-2876
Provider Enumeration Date:
12/27/2007