Provider First Line Business Practice Location Address:
761 N THORNTON ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854-6105
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-773-5437
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/28/2012