Provider First Line Business Practice Location Address:
1856 W BROADWAY 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:
99201-1820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-325-3588
Provider Business Practice Location Address Fax Number:
509-325-3597
Provider Enumeration Date:
11/07/2006