Provider First Line Business Practice Location Address:
714 E BOONE
Provider Second Line Business Practice Location Address:
AD BOX 25
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99258-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-328-4220
Provider Business Practice Location Address Fax Number:
509-228-9542
Provider Enumeration Date:
04/21/2006