Provider First Line Business Practice Location Address:
1224 N IDAHO ST STE 3
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:
83854-8615
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-625-8617
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2008