Provider First Line Business Practice Location Address:
6021 N. LIDGERWOOD 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:
99208-5549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-722-9700
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/10/2023