Provider First Line Business Practice Location Address:
2236 N MERRIT CRK LOOP STE A
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-625-3800
Provider Business Practice Location Address Fax Number:
208-625-3801
Provider Enumeration Date:
11/04/2014