Provider First Line Business Practice Location Address:
5240 W LOWELL 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:
99208-6499
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-816-6003
Provider Business Practice Location Address Fax Number:
509-816-6533
Provider Enumeration Date:
12/08/2020