Provider First Line Business Practice Location Address:
3609 E 22ND 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:
99223-3910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-356-7493
Provider Business Practice Location Address Fax Number:
509-443-4683
Provider Enumeration Date:
06/10/2026