Provider First Line Business Practice Location Address:
112 W MONTGOMERY AVE
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99205-4838
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-475-5534
Provider Business Practice Location Address Fax Number:
509-475-5534
Provider Enumeration Date:
11/03/2011