Provider First Line Business Practice Location Address:
1002 S OSWALD ST
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:
99224-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-445-4618
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2016