Provider First Line Business Practice Location Address:
417 W 1ST AVE STE 1B
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:
99201-6001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-747-9999
Provider Business Practice Location Address Fax Number:
509-835-4444
Provider Enumeration Date:
11/01/2019