Provider First Line Business Practice Location Address:
423 N THIRD AVE STE 335
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-265-7070
Provider Business Practice Location Address Fax Number:
208-265-7071
Provider Enumeration Date:
05/24/2005