Provider First Line Business Practice Location Address:
5505 S PERRY 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:
99223-6344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-593-0493
Provider Business Practice Location Address Fax Number:
509-321-7178
Provider Enumeration Date:
03/18/2021