Provider First Line Business Practice Location Address:
111 E CENTRAL AVE
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:
99208-1108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-265-2209
Provider Business Practice Location Address Fax Number:
360-240-0022
Provider Enumeration Date:
01/13/2020