Provider First Line Business Practice Location Address:
1612 E 7TH AVE APT B
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:
99202-3324
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-953-9753
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/18/2014