Provider First Line Business Practice Location Address:
231 N THIRD AVE
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
SANDPOINT
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83864-1418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-255-6931
Provider Business Practice Location Address Fax Number:
208-209-6001
Provider Enumeration Date:
06/06/2011