Provider First Line Business Practice Location Address:
215 10TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISTON
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83501-1910
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-743-5899
Provider Business Practice Location Address Fax Number:
208-743-9130
Provider Enumeration Date:
02/27/2020