Provider First Line Business Practice Location Address:
900 N HIGHWAY 41 STE 2
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:
83854-8823
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-981-0132
Provider Business Practice Location Address Fax Number:
208-981-0066
Provider Enumeration Date:
01/16/2014