Provider First Line Business Practice Location Address:
1324 N LIBERTY LAKE RD # 193
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIBERTY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99019
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-795-1967
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/26/2009