Provider First Line Business Practice Location Address:
1224 N IDAHO 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:
83854-9016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-232-8955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/30/2026