Provider First Line Business Practice Location Address:
1327 N STANFORD LANE
Provider Second Line Business Practice Location Address:
SUITE B
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:
509-891-7070
Provider Business Practice Location Address Fax Number:
509-891-4741
Provider Enumeration Date:
06/27/2007