Provider First Line Business Practice Location Address:
2003 KOOTENAI HEALTH WAY
Provider Second Line Business Practice Location Address:
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:
83814-6051
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-625-5678
Provider Business Practice Location Address Fax Number:
208-625-5677
Provider Enumeration Date:
09/29/2019