Provider First Line Business Practice Location Address:
1306 E 29TH 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:
99203-3228
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-443-3049
Provider Business Practice Location Address Fax Number:
509-443-3049
Provider Enumeration Date:
07/05/2012