Provider First Line Business Practice Location Address:
5809 HIGHWAY 2 STE 105
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:
83856-6097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
509-589-1254
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2021