Provider First Line Business Practice Location Address:
101 W 8TH AVE
Provider Second Line Business Practice Location Address:
MOTHER GAMELIN CENTER 3RD FLR
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99204-2307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-474-2072
Provider Business Practice Location Address Fax Number:
509-474-6606
Provider Enumeration Date:
05/26/2006