Provider First Line Business Practice Location Address:
100 N MULLAN RD
Provider Second Line Business Practice Location Address:
SUITE #204
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-6848
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-928-8400
Provider Business Practice Location Address Fax Number:
509-928-1845
Provider Enumeration Date:
07/19/2006