Provider First Line Business Practice Location Address:
2110 N MOLTER RD STE 108
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:
99019-9811
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-255-3785
Provider Business Practice Location Address Fax Number:
509-992-1572
Provider Enumeration Date:
07/15/2016