Provider First Line Business Practice Location Address:
925 E. POLSTON AVE.
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:
208-618-0787
Provider Business Practice Location Address Fax Number:
208-618-0796
Provider Enumeration Date:
03/25/2010