Provider First Line Business Practice Location Address:
24326 E MAXWELL AVE
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:
99019-8633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-218-3443
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/30/2019