Provider First Line Business Practice Location Address:
144 S POPLAR 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:
99201-5812
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-502-1413
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/14/2020