Provider First Line Business Practice Location Address:
606 N 3RD AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
SANDPOINT
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83864-1594
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-965-8118
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/17/2010