Provider First Line Business Practice Location Address:
14319 N DAKOTA 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:
99208-9541
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-426-4101
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/09/2023