Provider First Line Business Practice Location Address:
1123 W FAIRVIEW 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:
99205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-392-7230
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2016