Provider First Line Business Practice Location Address:
1165 W SNOQUALMIE 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:
83854-8129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-457-1114
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/30/2012