Provider First Line Business Practice Location Address:
731 S GARFIELD ST APT 9
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:
99202-5089
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-535-4525
Provider Business Practice Location Address Fax Number:
509-255-3247
Provider Enumeration Date:
09/26/2023