Provider First Line Business Practice Location Address:
1551 E MULLAN AVE BLDG A STE 200D
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:
83854-4868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-618-6070
Provider Business Practice Location Address Fax Number:
208-618-8903
Provider Enumeration Date:
03/26/2008