Provider First Line Business Practice Location Address:
3728 E BRIDGEPORT AVE
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:
99217-6929
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-853-9609
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2026