Provider First Line Business Practice Location Address:
404 W 15TH AVE
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:
99203-2110
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-838-8538
Provider Business Practice Location Address Fax Number:
509-455-8761
Provider Enumeration Date:
08/31/2006