Provider First Line Business Practice Location Address:
1304 N LIBERTY LAKE RD
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:
99019-8523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-891-6967
Provider Business Practice Location Address Fax Number:
509-891-0584
Provider Enumeration Date:
06/21/2012