Provider First Line Business Practice Location Address:
1224 N IDAHO ST STE 2
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:
83854-9024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-610-3779
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/12/2022