Provider First Line Business Practice Location Address:
151 W 3RD AVE UNIT 102
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:
83854-4038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-618-8878
Provider Business Practice Location Address Fax Number:
208-618-8879
Provider Enumeration Date:
06/29/2023