Provider First Line Business Practice Location Address:
LAKESIDE PEDIATRIC & ADOLESCENT MEDICINE
Provider Second Line Business Practice Location Address:
980 W IRONWOOD DRIVE SUITE 302
Provider Business Practice Location Address City Name:
COEUR D'ALENE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-267-9129
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2015