Provider First Line Business Practice Location Address:
212 N 1ST AVE STE 200
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:
83864-1451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-946-5242
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/01/2011