Provider First Line Business Practice Location Address:
421 W RIVERSIDE AVE STE 770
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:
99201-0402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-747-6148
Provider Business Practice Location Address Fax Number:
509-638-6705
Provider Enumeration Date:
12/04/2007