Provider First Line Business Practice Location Address:
3804 S DEARBORN 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:
99223-1239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-939-4042
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2006