Provider First Line Business Practice Location Address:
1521 E ILLINOIS AVE STE 204
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:
99207-5147
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-565-7005
Provider Business Practice Location Address Fax Number:
509-591-4947
Provider Enumeration Date:
04/24/2008