Provider First Line Business Practice Location Address:
4407 N DIVISION ST
Provider Second Line Business Practice Location Address:
STE. 603
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99207-1600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-467-4931
Provider Business Practice Location Address Fax Number:
509-464-2094
Provider Enumeration Date:
01/09/2007