Provider First Line Business Practice Location Address:
12929 E SPRAGUE AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-0721
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-891-2368
Provider Business Practice Location Address Fax Number:
509-891-2368
Provider Enumeration Date:
06/16/2011