Provider First Line Business Practice Location Address:
3010 W HAWTHORNE 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:
99208-9608
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-565-5376
Provider Business Practice Location Address Fax Number:
253-590-4359
Provider Enumeration Date:
09/29/2026