Provider First Line Business Practice Location Address:
2081 W GRANGE 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:
83854-9659
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-457-1999
Provider Business Practice Location Address Fax Number:
208-981-3777
Provider Enumeration Date:
10/21/2008