Provider First Line Business Practice Location Address:
520 N THIRD AVE
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:
83864-1507
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-265-3325
Provider Business Practice Location Address Fax Number:
208-263-1878
Provider Enumeration Date:
05/28/2010