Provider First Line Business Practice Location Address:
7583 N. MAIN STREET HWY 95
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONNERS FERRY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83805-1837
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-267-1801
Provider Business Practice Location Address Fax Number:
208-267-9020
Provider Enumeration Date:
05/04/2010