Provider First Line Business Practice Location Address:
1810 E SCHNEIDMILLER AVE STE 241
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:
83854-6374
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-777-1805
Provider Business Practice Location Address Fax Number:
208-777-1806
Provider Enumeration Date:
01/23/2014