Provider First Line Business Practice Location Address:
2808 S ASSEMBLY RD
Provider Second Line Business Practice Location Address:
APT. 75
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99224-5062
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-280-3886
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/06/2007