Provider First Line Business Practice Location Address:
4929 N MARTIN 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:
99207-4127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-235-4315
Provider Business Practice Location Address Fax Number:
509-795-2226
Provider Enumeration Date:
07/21/2026