Provider First Line Business Practice Location Address: 
546 N JEFFERSON LN STE 200
    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: 
99201-7104
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
509-625-3700
    Provider Business Practice Location Address Fax Number: 
509-625-3747
    Provider Enumeration Date: 
11/14/2006