Provider First Line Business Practice Location Address:
23225 E BOONE AVE
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:
99019-9557
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-964-4683
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2015