Provider First Line Business Practice Location Address:
19923 E 1ST CT
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:
99016-5152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-655-0137
Provider Business Practice Location Address Fax Number:
509-570-1865
Provider Enumeration Date:
02/16/2026