Provider First Line Business Practice Location Address:
711 N DUNDEE DR
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:
83854-8886
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-699-2950
Provider Business Practice Location Address Fax Number:
208-777-1218
Provider Enumeration Date:
11/01/2009