Provider First Line Business Practice Location Address:
1440 E MULLAN AVE
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:
83854-9064
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-619-4100
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/02/2006