Provider First Line Business Practice Location Address:
123 W FRANCIS AVE
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:
99205-6364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-483-9363
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/22/2008