Provider First Line Business Practice Location Address:
1414 N VERCLER RD
Provider Second Line Business Practice Location Address:
BLDG 5
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-385-0302
Provider Business Practice Location Address Fax Number:
509-385-0304
Provider Enumeration Date:
01/18/2013