Provider First Line Business Practice Location Address:
3773 W 5TH AVE STE 101
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:
83854-8746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-867-8544
Provider Business Practice Location Address Fax Number:
208-619-4497
Provider Enumeration Date:
05/29/2019