Provider First Line Business Practice Location Address:
3000 E SELTICE WAY STE 14
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:
83854-5590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-714-4448
Provider Business Practice Location Address Fax Number:
877-769-9729
Provider Enumeration Date:
04/09/2012