Provider First Line Business Practice Location Address:
1233 N LIBERTY LAKE RD
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:
99019-7518
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-893-1202
Provider Business Practice Location Address Fax Number:
509-893-7578
Provider Enumeration Date:
11/12/2010