Provider First Line Business Practice Location Address:
110 N. THIRD 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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-946-6746
Provider Business Practice Location Address Fax Number:
188-832-0983
Provider Enumeration Date:
04/02/2008