Provider First Line Business Practice Location Address:
9631 N NEVADA ST
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99218-1133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-688-8710
Provider Business Practice Location Address Fax Number:
509-688-6790
Provider Enumeration Date:
05/08/2009