Provider First Line Business Practice Location Address:
820 S MCCLELLAN #314
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:
99204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-353-3973
Provider Business Practice Location Address Fax Number:
509-838-8275
Provider Enumeration Date:
11/28/2006