Provider First Line Business Practice Location Address:
606 S MONROE AVE
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:
83864-2500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-610-7340
Provider Business Practice Location Address Fax Number:
208-920-6162
Provider Enumeration Date:
07/07/2014