Provider First Line Business Practice Location Address:
711 W JOSEPH 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:
99205-6409
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-328-0579
Provider Business Practice Location Address Fax Number:
509-328-4806
Provider Enumeration Date:
09/27/2007