Provider First Line Business Practice Location Address:
1327 SUPERIOR ST
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:
83864-1735
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-263-5731
Provider Business Practice Location Address Fax Number:
208-265-4716
Provider Enumeration Date:
01/10/2007