Provider First Line Business Practice Location Address:
914 W CARLISLE 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:
99205-3309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-340-1565
Provider Business Practice Location Address Fax Number:
509-326-5225
Provider Enumeration Date:
11/15/2018