Provider First Line Business Practice Location Address:
615 E SIXTH AVE
Provider Second Line Business Practice Location Address:
SUITE A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-262-9969
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/06/2008