Provider First Line Business Practice Location Address:
4171 W EXPO PKWY
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:
83854-7322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-457-7078
Provider Business Practice Location Address Fax Number:
208-457-7079
Provider Enumeration Date:
04/06/2006