Provider First Line Business Practice Location Address:
1908 N DALE LN
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:
99212-2445
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-327-5857
Provider Business Practice Location Address Fax Number:
509-327-6025
Provider Enumeration Date:
09/14/2006