Provider First Line Business Practice Location Address:
1700 E SCHNEIDMILLER AVE
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:
83854-7085
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-619-0190
Provider Business Practice Location Address Fax Number:
208-619-0196
Provider Enumeration Date:
04/29/2014