Provider First Line Business Practice Location Address:
9203 N JAMES CT
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:
99208-9173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-808-3448
Provider Business Practice Location Address Fax Number:
509-984-4075
Provider Enumeration Date:
10/31/2025