Provider First Line Business Practice Location Address:
614 E SELTICE WAY STE A
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:
83854-6367
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-640-1117
Provider Business Practice Location Address Fax Number:
208-777-9100
Provider Enumeration Date:
02/04/2013