Provider First Line Business Practice Location Address:
54 MERRITT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRIEST RIVER
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83856-6563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-240-0183
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/19/2024