Provider First Line Business Practice Location Address:
2110 N MOLTER RD STE 112
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:
208-277-9704
Provider Business Practice Location Address Fax Number:
208-277-9704
Provider Enumeration Date:
06/05/2008