Provider First Line Business Practice Location Address:
3124 S REGAL ST
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:
99223-4704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-464-6208
Provider Business Practice Location Address Fax Number:
888-316-1928
Provider Enumeration Date:
07/09/2006