Provider First Line Business Practice Location Address:
9915 N IVANHOE RD
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:
99218-2323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-228-9647
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/06/2025