Provider First Line Business Practice Location Address:
1420 E 3RD AVE STE 203
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:
83854-7580
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
866-508-4870
Provider Business Practice Location Address Fax Number:
866-627-4071
Provider Enumeration Date:
12/31/2013