Provider First Line Business Practice Location Address:
1301 S CARNAHAN RD APT E208
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:
99212-3309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-777-6679
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/02/2025