Provider First Line Business Practice Location Address:
12205 E 12TH AVE
Provider Second Line Business Practice Location Address:
STE. 5
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-5461
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-998-4798
Provider Business Practice Location Address Fax Number:
509-927-0082
Provider Enumeration Date:
03/28/2007