Provider First Line Business Practice Location Address:
5217 W SHAWNEE AVE
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:
99208-9403
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-816-2351
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/28/2025