Provider First Line Business Practice Location Address:
4129 E EARLY DAWN AVE STE 106
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:
83854-7990
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-625-3150
Provider Business Practice Location Address Fax Number:
208-625-5636
Provider Enumeration Date:
05/06/2024