Provider First Line Business Practice Location Address:
2310 N MOLTER RD STE 105
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:
99019-8621
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-891-7867
Provider Business Practice Location Address Fax Number:
509-922-0984
Provider Enumeration Date:
03/09/2010