Provider First Line Business Practice Location Address:
6018 N ASTOR ST
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:
99208-1107
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-482-2475
Provider Business Practice Location Address Fax Number:
509-482-2490
Provider Enumeration Date:
10/15/2008