Provider First Line Business Practice Location Address:
11530 E SPRAGUE AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-5135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-720-8138
Provider Business Practice Location Address Fax Number:
509-408-5377
Provider Enumeration Date:
07/26/2007