Provider First Line Business Practice Location Address:
1373 S BAKER LN
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:
83854-4609
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-516-1514
Provider Business Practice Location Address Fax Number:
855-595-2480
Provider Enumeration Date:
02/10/2020