Provider First Line Business Practice Location Address:
16010 E INDIANA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPOKANE VALLEY
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99216-1813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-928-8040
Provider Business Practice Location Address Fax Number:
509-928-0784
Provider Enumeration Date:
12/19/2022