Provider First Line Business Practice Location Address:
12120 E BROADWAY 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:
99206-7067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-926-6238
Provider Business Practice Location Address Fax Number:
509-926-6239
Provider Enumeration Date:
07/13/2016