Provider First Line Business Practice Location Address:
706 E SELTICE WAY
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:
83854-8674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-777-4071
Provider Business Practice Location Address Fax Number:
208-773-0913
Provider Enumeration Date:
07/29/2006