Provider First Line Business Practice Location Address:
12805 E SPRAGUE AVE
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:
99216-0795
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-924-5661
Provider Business Practice Location Address Fax Number:
509-924-5978
Provider Enumeration Date:
12/06/2010