Provider First Line Business Practice Location Address:
3807 E BISMARK 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:
99217-6504
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-279-2629
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/18/2010