Provider First Line Business Practice Location Address:
1315 HIGHWAY 2 STE 5
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:
83864-2724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-627-2129
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/05/2021