Provider First Line Business Practice Location Address:
3145 E MULLAN AVE STE 500
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:
83854-8901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-981-0129
Provider Business Practice Location Address Fax Number:
888-443-4939
Provider Enumeration Date:
08/21/2023