Provider First Line Business Practice Location Address:
3707 S GRAND BLVD STE A
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:
99203-2762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-747-0274
Provider Business Practice Location Address Fax Number:
509-747-3220
Provider Enumeration Date:
12/10/2019