Provider First Line Business Practice Location Address:
1327 N STANFORD LN
Provider Second Line Business Practice Location Address:
SUITE B
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:
509-891-7070
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2017