Provider First Line Business Practice Location Address:
101 N HOWARD ST
Provider Second Line Business Practice Location Address:
SUITE R
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-522-8169
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2023