Provider First Line Business Practice Location Address:
606 W JAY 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:
99218-2139
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-443-5150
Provider Business Practice Location Address Fax Number:
509-816-1999
Provider Enumeration Date:
11/24/2025