Provider First Line Business Practice Location Address:
624 W HASTINGS RD STE 14A
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:
99218-2877
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-552-7480
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/19/2019