Provider First Line Business Practice Location Address:
1235 N LIBERTY LAKE RD
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
LIBERTY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99019-7581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-434-9959
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2009