Provider First Line Business Practice Location Address:
4515 S REGAL 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:
99223-7938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-448-9585
Provider Business Practice Location Address Fax Number:
509-448-7896
Provider Enumeration Date:
06/07/2006