Provider First Line Business Practice Location Address:
20 S PINES RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99206-5136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-891-5299
Provider Business Practice Location Address Fax Number:
509-891-6852
Provider Enumeration Date:
11/16/2006