Provider First Line Business Practice Location Address:
640 N. THORNTON 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-262-8166
Provider Business Practice Location Address Fax Number:
208-262-8168
Provider Enumeration Date:
09/25/2013