Provider First Line Business Practice Location Address:
313 N SPOKANE ST
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:
83854-9513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-773-4579
Provider Business Practice Location Address Fax Number:
208-773-0286
Provider Enumeration Date:
09/14/2006