Provider First Line Business Practice Location Address:
319 W HASTINGS RD STE A107
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:
99218-5021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-228-2218
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2026