Provider First Line Business Practice Location Address:
3919 N MAPLE 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:
99205-1349
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-343-1116
Provider Business Practice Location Address Fax Number:
509-434-0283
Provider Enumeration Date:
01/29/2013