Provider First Line Business Practice Location Address:
2820 N ASTOR ST
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:
99207-2112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-838-0870
Provider Business Practice Location Address Fax Number:
509-455-5464
Provider Enumeration Date:
08/31/2006