Provider First Line Business Practice Location Address:
1215 N KANIKSU ST
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:
83854-7261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-998-9978
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/16/2007