Provider First Line Business Practice Location Address:
12509 E MISSION AVE
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-928-3600
Provider Business Practice Location Address Fax Number:
509-922-7244
Provider Enumeration Date:
10/05/2006