Provider First Line Business Practice Location Address:
N 900 HIGHWAY 41
Provider Second Line Business Practice Location Address:
STE 2&3
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854-8816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-457-7100
Provider Business Practice Location Address Fax Number:
208-457-7098
Provider Enumeration Date:
08/10/2022