Provider First Line Business Practice Location Address:
1403 S GRAND BLVD., SUITE 101S
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:
99203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-838-2225
Provider Business Practice Location Address Fax Number:
509-755-2225
Provider Enumeration Date:
11/15/2010