Provider First Line Business Practice Location Address:
12310 N DIVISION ST
Provider Second Line Business Practice Location Address:
STE. 105
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99218-1998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-466-1117
Provider Business Practice Location Address Fax Number:
509-464-0578
Provider Enumeration Date:
10/25/2006