Provider First Line Business Practice Location Address:
12709 E MIRABEAU PKWY
Provider Second Line Business Practice Location Address:
BLDG A STE 200
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-591-0070
Provider Business Practice Location Address Fax Number:
509-396-9661
Provider Enumeration Date:
08/31/2009