Provider First Line Business Practice Location Address:
6615 COMANCHE STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BONNERS FERRY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83805
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
931-879-5864
Provider Business Practice Location Address Fax Number:
931-879-3903
Provider Enumeration Date:
05/22/2006