Provider First Line Business Practice Location Address:
4808 N CANNON 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:
99205-5622
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-638-8913
Provider Business Practice Location Address Fax Number:
509-927-4761
Provider Enumeration Date:
04/19/2017