Provider First Line Business Practice Location Address:
1912 N DIVISION ST STE 102
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:
99207-2271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-328-6731
Provider Business Practice Location Address Fax Number:
509-328-4327
Provider Enumeration Date:
03/09/2007