Provider First Line Business Practice Location Address:
124 E AUGUSTA AVE STE 300
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:
99207-2479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-292-2466
Provider Business Practice Location Address Fax Number:
509-292-9672
Provider Enumeration Date:
07/10/2006