Provider First Line Business Practice Location Address:
604 N 5TH 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:
83864-1520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-263-1408
Provider Business Practice Location Address Fax Number:
208-265-8784
Provider Enumeration Date:
10/29/2014