Provider First Line Business Practice Location Address:
23403 E MISSION AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LIBERTY LAKE
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
99019-7553
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-893-1119
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/04/2006