Provider First Line Business Practice Location Address:
784 S CLEARWATER LOOP
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:
83854-9599
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-495-6400
Provider Business Practice Location Address Fax Number:
800-396-5232
Provider Enumeration Date:
06/29/2023