Provider First Line Business Practice Location Address:
111 W NORTH RIVER DR
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-3204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-315-8758
Provider Business Practice Location Address Fax Number:
509-315-8944
Provider Enumeration Date:
05/05/2011