Provider First Line Business Practice Location Address:
8807 E KNOX AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99212-2315
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-481-7189
Provider Business Practice Location Address Fax Number:
150-947-1346
Provider Enumeration Date:
03/28/2014