Provider First Line Business Practice Location Address:
5919 S COOK 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:
99223-6919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-448-5660
Provider Business Practice Location Address Fax Number:
509-448-3536
Provider Enumeration Date:
03/28/2007