Provider First Line Business Practice Location Address:
166 S COEUR DALENE ST
Provider Second Line Business Practice Location Address:
#D203
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-6452
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-953-6035
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2007