Provider First Line Business Practice Location Address:
1124 W RIVERSIDE AVE
Provider Second Line Business Practice Location Address:
SUITE LL2
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-1109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-455-8819
Provider Business Practice Location Address Fax Number:
509-455-8903
Provider Enumeration Date:
12/05/2005