Provider First Line Business Practice Location Address:
1220 E POLSTON 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-273-1577
Provider Business Practice Location Address Fax Number:
208-773-8585
Provider Enumeration Date:
07/12/2005