Provider First Line Business Practice Location Address:
4726 N OAK ST
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:
99205-5569
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-869-8573
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/15/2009