Provider First Line Business Practice Location Address:
302 E WEDGEWOOD AVE
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:
99208-5393
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-483-7136
Provider Business Practice Location Address Fax Number:
509-483-5161
Provider Enumeration Date:
12/23/2015