Provider First Line Business Practice Location Address:
E 23505 APPLEWAY
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
503-789-8651
Provider Business Practice Location Address Fax Number:
509-210-5289
Provider Enumeration Date:
02/05/2013