Provider First Line Business Practice Location Address:
212 E CENTRAL AVE
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208-6291
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-667-5536
Provider Business Practice Location Address Fax Number:
208-765-1194
Provider Enumeration Date:
08/24/2010