Provider First Line Business Practice Location Address:
7307 N DIVISION ST
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208-6545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-468-0866
Provider Business Practice Location Address Fax Number:
509-468-8403
Provider Enumeration Date:
08/04/2010