Provider First Line Business Practice Location Address:
4110 E SPRAGUE 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:
99202-4851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-534-7367
Provider Business Practice Location Address Fax Number:
509-534-0857
Provider Enumeration Date:
08/30/2012