Provider First Line Business Practice Location Address:
21801 E COUNTRY VISTA DR STE 105
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:
99019-7727
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-926-5272
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/25/2007