Provider First Line Business Practice Location Address:
4909 E UPRIVER DR
Provider Second Line Business Practice Location Address:
APT M204
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99217-7201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-591-1119
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/01/2011