Provider First Line Business Practice Location Address:
2005 E 29TH AVENUE
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:
99203-3957
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-747-0770
Provider Business Practice Location Address Fax Number:
509-624-0620
Provider Enumeration Date:
08/10/2006