Provider First Line Business Practice Location Address:
5418 E 25TH AVE
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:
99223-2311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-791-0413
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/23/2009