Provider First Line Business Practice Location Address:
1224 N IDAHO ST STE 7
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:
83854-9024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-944-5467
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/17/2014