Provider First Line Business Practice Location Address:
323 S. GREENRIDGE DR.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-808-9766
Provider Business Practice Location Address Fax Number:
509-891-8999
Provider Enumeration Date:
05/03/2007