Provider First Line Business Practice Location Address:
609 N CALGARY CT STE 104
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:
83854-8165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-777-1222
Provider Business Practice Location Address Fax Number:
208-777-4555
Provider Enumeration Date:
03/20/2008