Provider First Line Business Practice Location Address:
6811 MAIN ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
BONNERS FERRY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83805-8649
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-267-6454
Provider Business Practice Location Address Fax Number:
208-267-6457
Provider Enumeration Date:
06/04/2008