Provider First Line Business Practice Location Address:
1210 WASHINGTON 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:
83864-5052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-263-4488
Provider Business Practice Location Address Fax Number:
208-265-6727
Provider Enumeration Date:
08/05/2008