Provider First Line Business Practice Location Address:
4019 E CENTRAL AVE
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:
99217
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-325-4489
Provider Business Practice Location Address Fax Number:
509-325-5034
Provider Enumeration Date:
05/22/2019