Provider First Line Business Practice Location Address:
2323 E BRIDGEPORT AVE
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:
99207-5705
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-354-2341
Provider Business Practice Location Address Fax Number:
509-354-2310
Provider Enumeration Date:
09/07/2022