Provider First Line Business Practice Location Address:
1521 E ILLINOIS AVE STE 201
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:
99207-5147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-270-4173
Provider Business Practice Location Address Fax Number:
509-270-4173
Provider Enumeration Date:
10/13/2009