Provider First Line Business Practice Location Address:
312 S FIRST AVE LOWR LEVEL
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:
83864-1202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-263-7727
Provider Business Practice Location Address Fax Number:
208-263-7728
Provider Enumeration Date:
10/29/2007