Provider First Line Business Practice Location Address:
22910 E APPLEWAY AVE
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
LIBERTY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99019-8605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-242-0911
Provider Business Practice Location Address Fax Number:
509-242-0913
Provider Enumeration Date:
11/08/2013