Provider First Line Business Practice Location Address:
5408 N HOWARD 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:
99205-5216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-558-7392
Provider Business Practice Location Address Fax Number:
509-242-3632
Provider Enumeration Date:
02/17/2026