Provider First Line Business Practice Location Address: 
217 W CATALDO AVE FL 3
    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: 
99201-2217
    Provider Business Practice Location Address Country Code: 
US
    Provider Business Practice Location Address Telephone Number: 
509-747-6194
    Provider Business Practice Location Address Fax Number: 
509-838-0824
    Provider Enumeration Date: 
04/19/2011