Provider First Line Business Practice Location Address:
218 E GORDON 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:
99207-1826
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-964-5268
Provider Business Practice Location Address Fax Number:
208-712-6002
Provider Enumeration Date:
10/21/2015