Provider First Line Business Practice Location Address:
1314 S GRAND BLVD STE 5
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:
99202-1174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-742-9275
Provider Business Practice Location Address Fax Number:
509-742-9277
Provider Enumeration Date:
12/06/2024