Provider First Line Business Practice Location Address:
724 N HIGHWAY 41 STE C
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:
83854-4977
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-434-9837
Provider Business Practice Location Address Fax Number:
903-434-9837
Provider Enumeration Date:
02/04/2026