Provider First Line Business Practice Location Address:
4002 W BROAD 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:
99205-6108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-957-3178
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/06/2026