Provider First Line Business Practice Location Address:
4703 N MAPLE ST
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:
99205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-325-3311
Provider Business Practice Location Address Fax Number:
509-325-4567
Provider Enumeration Date:
11/30/2006