Provider First Line Business Practice Location Address:
5324 W BENTWOOD 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:
99208-9451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-655-0137
Provider Business Practice Location Address Fax Number:
509-570-1865
Provider Enumeration Date:
02/16/2026