Provider First Line Business Practice Location Address:
5811 S DEARBORN RD
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:
99223-1752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-869-9541
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/30/2021