Provider First Line Business Practice Location Address:
6107 N ASTOR 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:
99208-8102
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-210-0550
Provider Business Practice Location Address Fax Number:
509-960-9003
Provider Enumeration Date:
05/31/2022