Provider First Line Business Practice Location Address:
21 S HOLIDAY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99016-5094
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-216-0495
Provider Business Practice Location Address Fax Number:
509-418-2165
Provider Enumeration Date:
11/02/2026