Provider First Line Business Practice Location Address:
23801 EAST APPLEWAY AVE
Provider Second Line Business Practice Location Address:
#110
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:
509-922-4133
Provider Business Practice Location Address Fax Number:
509-928-9639
Provider Enumeration Date:
01/11/2016