Provider First Line Business Practice Location Address:
1328 N STANFORD LN STE 100
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:
99019-5034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-891-5001
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2015