Provider First Line Business Practice Location Address:
9204 E GRACE 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:
99206-4308
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-385-5814
Provider Business Practice Location Address Fax Number:
509-214-1876
Provider Enumeration Date:
10/21/2026