Provider First Line Business Practice Location Address:
421 W RIVERSIDE AVE
Provider Second Line Business Practice Location Address:
SUITE 614
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-0405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-638-2113
Provider Business Practice Location Address Fax Number:
509-474-9756
Provider Enumeration Date:
12/07/2010