Provider First Line Business Practice Location Address:
306 N SPOKANE ST
Provider Second Line Business Practice Location Address:
SUITE I
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854-7016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-777-8500
Provider Business Practice Location Address Fax Number:
208-777-8721
Provider Enumeration Date:
10/18/2005