Provider First Line Business Practice Location Address:
724 N IDAHO 41 HWY
Provider Second Line Business Practice Location Address:
SUITE C
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:
509-808-4790
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2026