Provider First Line Business Practice Location Address:
5150 W EXPO PKWY
Provider Second Line Business Practice Location Address:
APT M-203
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:
509-818-9964
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2026