Provider First Line Business Practice Location Address:
522 W RIVERSIDE AVE
Provider Second Line Business Practice Location Address:
SUITE 6007
Provider Business Practice Location Address City Name:
SPOKANE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99201-0580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-594-2235
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2026