Provider First Line Business Practice Location Address:
1212 N WASHINGTON ST STE 124
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:
99201-2441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-443-3148
Provider Business Practice Location Address Fax Number:
509-443-3643
Provider Enumeration Date:
10/18/2018