Provider First Line Business Practice Location Address:
4717 N WASHINGTON 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:
99205-5131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-992-6434
Provider Business Practice Location Address Fax Number:
708-579-8303
Provider Enumeration Date:
06/26/2018