Provider First Line Business Practice Location Address:
5901 N LIDGERWOOD ST
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99208-1189
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-483-3566
Provider Business Practice Location Address Fax Number:
509-483-3592
Provider Enumeration Date:
11/01/2006