Provider First Line Business Practice Location Address:
6120 N MAYFAIR ST
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:
99208-1033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-688-6700
Provider Business Practice Location Address Fax Number:
509-484-9212
Provider Enumeration Date:
02/27/2007