Provider First Line Business Practice Location Address:
600 N CECIL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-667-9334
Provider Business Practice Location Address Fax Number:
208-664-2341
Provider Enumeration Date:
10/03/2006