Provider First Line Business Practice Location Address:
6025 N ELLA ST
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:
99217-9549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-366-0405
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/27/2026