Provider First Line Business Practice Location Address:
2207 N MOLTER RD STE 203
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:
99019-7571
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-565-8803
Provider Business Practice Location Address Fax Number:
509-842-3057
Provider Enumeration Date:
09/02/2021