Provider First Line Business Practice Location Address:
23505 E APPLEWAY AVE STE 106
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:
99019-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-210-0303
Provider Business Practice Location Address Fax Number:
509-242-3180
Provider Enumeration Date:
04/29/2016