Provider First Line Business Practice Location Address:
23403 E MISSION AVE STE 150
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:
99019-7554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-795-5501
Provider Business Practice Location Address Fax Number:
509-755-4974
Provider Enumeration Date:
04/24/2019