Provider First Line Business Practice Location Address:
12704 E NORA AVE STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1140
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-926-1531
Provider Business Practice Location Address Fax Number:
509-926-0956
Provider Enumeration Date:
10/18/2006