Provider First Line Business Practice Location Address:
21801 E COUNTRY VISTA DR
Provider Second Line Business Practice Location Address:
STE 105
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-926-5272
Provider Business Practice Location Address Fax Number:
509-926-4855
Provider Enumeration Date:
05/18/2006