Provider First Line Business Practice Location Address:
920 N HIGHWAY 41
Provider Second Line Business Practice Location Address:
SUITE 3-6
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854-8806
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
815-509-2878
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/16/2014