Provider First Line Business Practice Location Address:
2025 S BLAKE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-0414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-330-6500
Provider Business Practice Location Address Fax Number:
509-242-1806
Provider Enumeration Date:
10/14/2019