Provider First Line Business Practice Location Address:
3218 E 31ST AVE
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:
99223-3701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-939-7168
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/18/2010