Provider First Line Business Practice Location Address:
108 E INDIANA AVE
Provider Second Line Business Practice Location Address:
STE B
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99207-2316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-328-3344
Provider Business Practice Location Address Fax Number:
509-328-3644
Provider Enumeration Date:
05/18/2007