Provider First Line Business Practice Location Address:
3154 E 29TH AVE
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:
99223-4861
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
506-535-4607
Provider Business Practice Location Address Fax Number:
509-535-3021
Provider Enumeration Date:
05/16/2007