Provider First Line Business Practice Location Address:
1530 E 15TH 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:
99203-3604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-498-0461
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2011