Provider First Line Business Practice Location Address:
5901 N LIDGERWOOD ST STE 115
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:
99208-1122
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-838-4651
Provider Business Practice Location Address Fax Number:
509-363-2762
Provider Enumeration Date:
05/29/2019