Provider First Line Business Practice Location Address:
23505 E APPLEWAY AVE STE 200-102
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:
99019-6003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-844-7871
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/24/2023