Provider First Line Business Practice Location Address:
1431 N LIBERTY LAKE RD STE B
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:
99019-8522
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-928-6700
Provider Business Practice Location Address Fax Number:
509-928-0861
Provider Enumeration Date:
07/05/2021