Provider First Line Business Practice Location Address:
12007 E MANSFIELD AVE
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:
99206-4740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-954-4625
Provider Business Practice Location Address Fax Number:
509-315-5045
Provider Enumeration Date:
07/04/2010