Provider First Line Business Practice Location Address:
6614 E MAIN 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:
99212-0833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-587-0105
Provider Business Practice Location Address Fax Number:
509-689-1770
Provider Enumeration Date:
05/19/2006