Provider First Line Business Practice Location Address:
W 905 RIVERSIDE
Provider Second Line Business Practice Location Address:
STE 208
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-747-0165
Provider Business Practice Location Address Fax Number:
509-747-8016
Provider Enumeration Date:
10/21/2005