Provider First Line Business Practice Location Address:
8810 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:
99212-2372
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
206-940-0844
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/29/2026