Provider First Line Business Practice Location Address:
101 WEST 8TH 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:
99220-2555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-474-4503
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/11/2006