Provider First Line Business Practice Location Address:
1420 N MULLAN RD
Provider Second Line Business Practice Location Address:
SUITE L-5
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-4366
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-499-9266
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2009