Provider First Line Business Practice Location Address:
628 S MAPLE ST STE 101
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:
99204-3445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-456-7888
Provider Business Practice Location Address Fax Number:
509-838-7679
Provider Enumeration Date:
02/23/2007