Provider First Line Business Practice Location Address:
1551 E MULLAN AVE STE 200C
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:
83854-9005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-618-2570
Provider Business Practice Location Address Fax Number:
208-618-8779
Provider Enumeration Date:
07/12/2006