Provider First Line Business Practice Location Address:
104 S FREYA ST STE 209
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:
99202-4866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-704-2645
Provider Business Practice Location Address Fax Number:
877-376-4040
Provider Enumeration Date:
09/30/2025