Provider First Line Business Practice Location Address:
101 E HARTSON 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:
99202-1323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-624-9788
Provider Business Practice Location Address Fax Number:
509-624-1461
Provider Enumeration Date:
07/24/2018