Provider First Line Business Practice Location Address:
1334 N WHITMAN LN STE 202
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:
99019-6034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-960-5550
Provider Business Practice Location Address Fax Number:
509-474-1958
Provider Enumeration Date:
05/24/2021