Provider First Line Business Practice Location Address:
22 W INDIANA 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:
99205-4825
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-355-5950
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2026