Provider First Line Business Practice Location Address:
1005 N EVERGREEN RD
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1485
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-921-5666
Provider Business Practice Location Address Fax Number:
509-927-4842
Provider Enumeration Date:
08/30/2006