Provider First Line Business Practice Location Address:
1704 W NORTH FIVE MILE RD
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:
99208-7112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-230-4411
Provider Business Practice Location Address Fax Number:
509-466-0588
Provider Enumeration Date:
08/14/2006