Provider First Line Business Practice Location Address:
2700 E SELTICE WAY STE 1
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:
83854-6387
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-361-6325
Provider Business Practice Location Address Fax Number:
949-868-4649
Provider Enumeration Date:
12/31/2025