Provider First Line Business Practice Location Address:
104 S FREYA ST. SUITE 225B
Provider Second Line Business Practice Location Address:
TURQUOISE FLAG BUILDING,
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-289-4245
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/17/2025