Provider First Line Business Practice Location Address:
907 S PERRY ST STE 240
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:
99202-3462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-456-5433
Provider Business Practice Location Address Fax Number:
509-456-3557
Provider Enumeration Date:
08/22/2005