Provider First Line Business Practice Location Address:
1138 E POLELINE 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:
83854-6150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-777-5511
Provider Business Practice Location Address Fax Number:
724-426-8936
Provider Enumeration Date:
10/13/2023