Provider First Line Business Practice Location Address:
501 S BERNARD 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:
99204-2511
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-699-9626
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/05/2021