Provider First Line Business Practice Location Address:
3928 E BRIDGEPORT 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:
99217-6933
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-280-1176
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2019