Provider First Line Business Practice Location Address:
5720 N FOTHERINGHAM ST
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:
99205-7420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-981-0241
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2023