Provider First Line Business Practice Location Address:
5511 E 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99212-0726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-482-4266
Provider Business Practice Location Address Fax Number:
509-482-4270
Provider Enumeration Date:
11/04/2011