Provider First Line Business Practice Location Address:
626 N MULLAN RD
Provider Second Line Business Practice Location Address:
#4
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-3861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-892-5442
Provider Business Practice Location Address Fax Number:
509-892-5462
Provider Enumeration Date:
07/13/2007