Provider First Line Business Practice Location Address:
3012 N NEVADA ST STE 1
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:
99207-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-741-0440
Provider Business Practice Location Address Fax Number:
509-206-9500
Provider Enumeration Date:
09/08/2025