Provider First Line Business Practice Location Address:
1128 W SHARP 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:
99201-2629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-217-3511
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/11/2025