Provider First Line Business Practice Location Address:
570 S CLEARWATER LOOP STE B
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:
83854-5437
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-777-2169
Provider Business Practice Location Address Fax Number:
208-777-2189
Provider Enumeration Date:
09/18/2013