Provider First Line Business Practice Location Address:
2103 S GRAND BLVD
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:
99203-2349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-624-0542
Provider Business Practice Location Address Fax Number:
509-624-2332
Provider Enumeration Date:
11/17/2005