Provider First Line Business Practice Location Address:
305 N. LINCOLN STREET
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
POST FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83854-6412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-907-1790
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/12/2014