Provider First Line Business Practice Location Address:
12717 E 4TH AVE APT B201
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:
99216-0800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-970-8537
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/23/2026