Provider First Line Business Practice Location Address:
3504 S GLENROSE RD
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:
99223-1136
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
619-990-5208
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/15/2023