Provider First Line Business Practice Location Address:
1205 HIGHWAY 2 STE 304A
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:
83864-2734
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-350-2053
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/18/2016