Provider First Line Business Practice Location Address:
5125 N MARKET 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:
99217-6131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-536-8225
Provider Business Practice Location Address Fax Number:
509-458-7459
Provider Enumeration Date:
10/15/2019