Provider First Line Business Practice Location Address:
185 W 4TH AVE
Provider Second Line Business Practice Location Address:
STE C
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854-4979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-457-8746
Provider Business Practice Location Address Fax Number:
208-457-8767
Provider Enumeration Date:
05/01/2007