Provider First Line Business Practice Location Address:
602 N CALGARY CT
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-777-9331
Provider Business Practice Location Address Fax Number:
208-777-9335
Provider Enumeration Date:
01/18/2010