Provider First Line Business Practice Location Address:
400 S JEFFERSON ST STE 304
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:
99204-3144
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-903-5631
Provider Business Practice Location Address Fax Number:
503-296-5321
Provider Enumeration Date:
10/08/2025