Provider First Line Business Practice Location Address:
104 S FREYA ST STE 214A
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:
99202-6204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-795-0460
Provider Business Practice Location Address Fax Number:
509-940-0048
Provider Enumeration Date:
07/22/2024