Provider First Line Business Practice Location Address:
1620 E HOUSTON AVE STE 200
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:
99217-6006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-530-1145
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/14/2025