Provider First Line Business Practice Location Address:
601 S PARK RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99212-0593
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-921-7818
Provider Business Practice Location Address Fax Number:
509-891-0456
Provider Enumeration Date:
09/30/2007