Provider First Line Business Practice Location Address:
829 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:
99201-2117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-323-7600
Provider Business Practice Location Address Fax Number:
509-323-7602
Provider Enumeration Date:
09/16/2005