Provider First Line Business Practice Location Address:
601 E SELTICE WAY STE 6B
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:
83854-5337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-723-7122
Provider Business Practice Location Address Fax Number:
888-388-1771
Provider Enumeration Date:
04/23/2012