Provider First Line Business Practice Location Address:
104 S FREYA ST STE 226B
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:
99202-4887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-315-5787
Provider Business Practice Location Address Fax Number:
509-204-8188
Provider Enumeration Date:
12/15/2020