Provider First Line Business Practice Location Address:
3808 N SULLIVAN RD BLDG N15 SUITE 104
Provider Second Line Business Practice Location Address:
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-744-9891
Provider Business Practice Location Address Fax Number:
509-742-3494
Provider Enumeration Date:
09/12/2013