Provider First Line Business Practice Location Address:
1724 W CARLISLE AVE
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:
99205-3616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-343-4263
Provider Business Practice Location Address Fax Number:
509-489-6679
Provider Enumeration Date:
05/17/2007