Provider First Line Business Practice Location Address:
1003 E TRENT AVE
Provider Second Line Business Practice Location Address:
STE 150
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202-2180
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-688-6733
Provider Business Practice Location Address Fax Number:
509-688-6777
Provider Enumeration Date:
11/09/2006