Provider First Line Business Practice Location Address:
1919 N HOLL BLVD
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:
99016-5115
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-755-6794
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/10/2025