Provider First Line Business Practice Location Address:
1638 S MAPLE BLVD
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:
99203-1166
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-368-9066
Provider Business Practice Location Address Fax Number:
509-536-2811
Provider Enumeration Date:
10/10/2011