Provider First Line Business Practice Location Address:
11721 E BUCKEYE AVE
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:
99206-4670
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-927-7220
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/29/2005