Provider First Line Business Practice Location Address:
565 N VEST ST
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:
83854-7066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-773-2499
Provider Business Practice Location Address Fax Number:
208-773-6309
Provider Enumeration Date:
09/06/2006