Provider First Line Business Practice Location Address:
104 S FREYA OFB 214A
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:
99202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-534-9558
Provider Business Practice Location Address Fax Number:
509-534-3193
Provider Enumeration Date:
11/29/2006