Provider First Line Business Practice Location Address:
104 S FREYA ST
Provider Second Line Business Practice Location Address:
RED FLAG BLDG. #203
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202-4862
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-535-9135
Provider Business Practice Location Address Fax Number:
509-535-3981
Provider Enumeration Date:
01/31/2007