Provider First Line Business Practice Location Address:
4407 S MADELIA ST
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:
99223-6429
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-448-2692
Provider Business Practice Location Address Fax Number:
509-448-2692
Provider Enumeration Date:
05/12/2010