Provider First Line Business Practice Location Address:
11524 E 20TH AVE
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:
99206-7018
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-808-7151
Provider Business Practice Location Address Fax Number:
509-505-4390
Provider Enumeration Date:
10/23/2025