Provider First Line Business Practice Location Address:
24126 E SHARP 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:
99019-9590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-922-8283
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/29/2007