Provider First Line Business Practice Location Address:
417 N HENRY ST 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:
83854-6436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-889-9240
Provider Business Practice Location Address Fax Number:
208-777-2471
Provider Enumeration Date:
06/29/2020