Provider First Line Business Practice Location Address:
522 W RIVERSIDE AVE STE N
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:
99201-0581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
919-938-7558
Provider Business Practice Location Address Fax Number:
919-934-7554
Provider Enumeration Date:
01/15/2022