Provider First Line Business Practice Location Address:
185 W 4TH AVE STE B
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:
206-235-6171
Provider Business Practice Location Address Fax Number:
833-285-1133
Provider Enumeration Date:
04/24/2015