Provider First Line Business Practice Location Address:
1227 S LIBERTY DR
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:
99019-9736
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-536-9730
Provider Business Practice Location Address Fax Number:
509-535-3981
Provider Enumeration Date:
12/26/2013