Provider First Line Business Practice Location Address:
5506 N STONE ST
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:
99208-2967
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-385-1657
Provider Business Practice Location Address Fax Number:
509-385-1657
Provider Enumeration Date:
05/19/2026