Provider First Line Business Practice Location Address:
2420 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:
99207-2625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-251-6484
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/06/2025