Provider First Line Business Practice Location Address:
11319 E CARLISLE AVE 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:
99206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-533-0005
Provider Business Practice Location Address Fax Number:
509-533-1423
Provider Enumeration Date:
11/07/2005