Provider First Line Business Practice Location Address:
1334 N WHITMAN LN # 100
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:
99019-7594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-922-1810
Provider Business Practice Location Address Fax Number:
509-922-1823
Provider Enumeration Date:
03/07/2011