Provider First Line Business Practice Location Address:
9116 E SPRAGUE AVE APT B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-3601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-924-0067
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/24/2007