Provider First Line Business Practice Location Address:
1326 N STANFORD LN
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:
99019-5034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
506-755-6760
Provider Business Practice Location Address Fax Number:
509-755-6797
Provider Enumeration Date:
01/29/2018