Provider First Line Business Practice Location Address:
5916 S DIVISION ST
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:
99224-8415
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-723-9329
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2026