Provider First Line Business Practice Location Address:
2603 W WELLESLEY AVE
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:
99205-1582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-325-4227
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2018