Provider First Line Business Practice Location Address:
1205 HIGHWAY 2 STE 102
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:
83864-2740
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-353-5208
Provider Business Practice Location Address Fax Number:
866-365-5203
Provider Enumeration Date:
12/01/2006