Provider First Line Business Practice Location Address:
12903 EAST MISSION
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:
99216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-927-7148
Provider Business Practice Location Address Fax Number:
509-927-7176
Provider Enumeration Date:
03/22/2007