Provider First Line Business Practice Location Address:
2809 W BOONE 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:
99201-3002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-710-9996
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/07/2009