Provider First Line Business Practice Location Address:
640 N THORNTON ST
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:
83854-7495
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-773-2888
Provider Business Practice Location Address Fax Number:
208-806-0222
Provider Enumeration Date:
08/02/2024