Provider First Line Business Practice Location Address:
7115 N GREENWOOD PL
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:
99208-5063
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-326-6967
Provider Business Practice Location Address Fax Number:
509-800-4428
Provider Enumeration Date:
06/20/2025