Provider First Line Business Practice Location Address:
520 N 3RD AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDPOINT
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83864-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-263-1441
Provider Business Practice Location Address Fax Number:
208-265-1277
Provider Enumeration Date:
03/26/2009