Provider First Line Business Practice Location Address:
1011 E 2ND AVE
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202-2207
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-744-9891
Provider Business Practice Location Address Fax Number:
509-742-3494
Provider Enumeration Date:
12/28/2011