Provider First Line Business Practice Location Address:
104 S FREYA ST STE 109D
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:
99202-4892
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-554-5565
Provider Business Practice Location Address Fax Number:
509-381-3524
Provider Enumeration Date:
08/28/2023