Provider First Line Business Practice Location Address:
1206 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:
83854-5131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-457-8406
Provider Business Practice Location Address Fax Number:
208-457-9680
Provider Enumeration Date:
03/27/2007