Provider First Line Business Practice Location Address:
16609 E DESMET CT APT G107
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:
99216-3565
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
562-546-3842
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/20/2025