Provider First Line Business Practice Location Address:
2310 N MOLTER RD
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
LIBERTY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99019-5036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-924-4443
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/14/2010