Provider First Line Business Practice Location Address:
104 S FREYA ST
Provider Second Line Business Practice Location Address:
WHITE FLAG BUILDING STE 119
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202-4893
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-904-5230
Provider Business Practice Location Address Fax Number:
509-554-5567
Provider Enumeration Date:
03/23/2021