Provider First Line Business Practice Location Address:
12213 E BROADWAY AVE
Provider Second Line Business Practice Location Address:
SUITE 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:
99206-6131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-290-6044
Provider Business Practice Location Address Fax Number:
509-443-3928
Provider Enumeration Date:
09/16/2015