Provider First Line Business Practice Location Address:
23505 E APPLEWAY AVE
Provider Second Line Business Practice Location Address:
STE 106
Provider Business Practice Location Address City Name:
LIBERTY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99019-5061
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-891-2258
Provider Business Practice Location Address Fax Number:
509-891-2094
Provider Enumeration Date:
12/22/2005