Provider First Line Business Practice Location Address:
4118 S COOK 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:
99223-4425
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-816-2969
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/30/2026