Provider First Line Business Practice Location Address:
22011 E COUNTRY VISTA DR STE 201
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:
99019-5242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-927-9279
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/25/2006