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:
208-667-0585
Provider Business Practice Location Address Fax Number:
208-667-0876
Provider Enumeration Date:
10/27/2006