Provider First Line Business Practice Location Address:
4224 E PRAIRIE LANE 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:
99223-6025
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-818-7552
Provider Business Practice Location Address Fax Number:
833-362-1616
Provider Enumeration Date:
09/03/2026