Provider First Line Business Practice Location Address:
1719 N ATLANTIC 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:
99205-4804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-781-5536
Provider Business Practice Location Address Fax Number:
208-620-3985
Provider Enumeration Date:
01/22/2025