Provider First Line Business Practice Location Address:
1790 N WILLAMETTE 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:
99016-5058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-216-2454
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2023