Provider First Line Business Practice Location Address:
1020 S HAZELWOOD 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:
99224-9295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
425-245-3414
Provider Business Practice Location Address Fax Number:
509-418-0271
Provider Enumeration Date:
10/26/2026