Provider First Line Business Practice Location Address:
12509 E MISSION AVE STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-892-2480
Provider Business Practice Location Address Fax Number:
509-892-6708
Provider Enumeration Date:
09/21/2006