Provider First Line Business Practice Location Address:
958 S LOCHSA ST STE 307
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:
83854-8358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-213-1234
Provider Business Practice Location Address Fax Number:
208-413-6220
Provider Enumeration Date:
11/17/2025