Provider First Line Business Practice Location Address:
1910 E SCHNEIDMILLER AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854-5029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-777-8668
Provider Business Practice Location Address Fax Number:
208-457-8112
Provider Enumeration Date:
07/30/2008