Provider First Line Business Practice Location Address:
1810 E SCHNEIDMILLER AVE
Provider Second Line Business Practice Location Address:
SUITE 101-A
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854-7084
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-964-5522
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/01/2008