Provider First Line Business Practice Location Address:
801 S STEVENS ST
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:
99204-2654
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-747-4455
Provider Business Practice Location Address Fax Number:
509-363-7064
Provider Enumeration Date:
05/04/2006