Provider First Line Business Practice Location Address:
5707 N FREYA 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:
99217-6539
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-482-4031
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/26/2010