Provider First Line Business Practice Location Address:
1300 E MULLAN SUTE 1600
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-773-0721
Provider Business Practice Location Address Fax Number:
208-773-3306
Provider Enumeration Date:
02/28/2006