Provider First Line Business Practice Location Address:
415 W 15TH AVE
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:
83854-7215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-929-2525
Provider Business Practice Location Address Fax Number:
208-773-0746
Provider Enumeration Date:
07/11/2011