Provider First Line Business Practice Location Address:
414 S VIRGINIA LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-2584
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-340-0700
Provider Business Practice Location Address Fax Number:
509-800-2184
Provider Enumeration Date:
04/20/2026