Provider First Line Business Practice Location Address:
HC 60 BOX 13
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONNERS FERRY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83805-9503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-267-2803
Provider Business Practice Location Address Fax Number:
208-267-3048
Provider Enumeration Date:
08/20/2006