Provider First Line Business Practice Location Address:
9631 N NEVADA ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99218-1133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-688-6760
Provider Business Practice Location Address Fax Number:
509-688-6769
Provider Enumeration Date:
01/17/2008