Provider First Line Business Practice Location Address:
1551 E MULLAN AVE BLDG A
Provider Second Line Business Practice Location Address:
STE 200B
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:
208-262-2213
Provider Business Practice Location Address Fax Number:
208-262-2214
Provider Enumeration Date:
04/29/2020