Provider First Line Business Practice Location Address:
1421 N MEADOWWOOD LN STE 30
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:
99019-5037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-990-9470
Provider Business Practice Location Address Fax Number:
509-255-7790
Provider Enumeration Date:
10/03/2019