Provider First Line Business Practice Location Address:
1300 E MULLAN AVE STE 1300
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:
83854-6057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-625-5630
Provider Business Practice Location Address Fax Number:
208-625-5631
Provider Enumeration Date:
06/16/2014