Provider First Line Business Practice Location Address:
2207 N MOLTER RD STE 250
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:
99019-7582
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-699-8364
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/17/2018