Provider First Line Business Practice Location Address:
1718 E LINCOLN RD
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:
99217-7775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-868-1933
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2005