Provider First Line Business Practice Location Address:
6405 W POINTE PKWY
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:
83854-6948
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-777-4212
Provider Business Practice Location Address Fax Number:
208-777-4234
Provider Enumeration Date:
04/26/2006