Provider First Line Business Practice Location Address:
1209 W 1ST 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:
99201-4101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-995-3388
Provider Business Practice Location Address Fax Number:
509-321-4350
Provider Enumeration Date:
09/30/2019