Provider First Line Business Practice Location Address:
1334 N WHITMAN LN STE 200
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:
208-457-4208
Provider Business Practice Location Address Fax Number:
208-457-4197
Provider Enumeration Date:
08/04/2022