Provider First Line Business Practice Location Address:
2712 N CHASE RD
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:
99019-8632
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-747-7134
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/15/2009