Provider First Line Business Practice Location Address:
5349 E DORADO 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:
83854-4997
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-892-9245
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2026