Provider First Line Business Practice Location Address:
11402 N NEWPORT HWY STE A
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:
99218-1661
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-352-7814
Provider Business Practice Location Address Fax Number:
509-362-9875
Provider Enumeration Date:
08/17/2018