Provider First Line Business Practice Location Address:
1114 W 20TH AVE
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:
99203-1147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-230-3745
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2006