Provider First Line Business Practice Location Address:
5112 N ADAMS 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:
99205-5410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-304-8059
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/27/2020