Provider First Line Business Practice Location Address:
514 E MAXINE 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:
99218-1117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-245-9447
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/24/2026