Provider First Line Business Practice Location Address:
1100 W MALLON 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:
99260-2043
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-477-6674
Provider Business Practice Location Address Fax Number:
509-477-6683
Provider Enumeration Date:
11/21/2018