Provider First Line Business Practice Location Address:
4927 N WASHINGTON 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:
99205-5135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
661-802-6050
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/09/2025