Provider First Line Business Practice Location Address:
405 E HARTSON AVE STE 4
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:
99202-1329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-624-2545
Provider Business Practice Location Address Fax Number:
509-624-1438
Provider Enumeration Date:
01/13/2015