Provider First Line Business Practice Location Address:
820 N WILLIAM ST
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:
83854-5123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-755-0660
Provider Business Practice Location Address Fax Number:
208-777-7691
Provider Enumeration Date:
10/10/2019