Provider First Line Business Practice Location Address:
708 W SUPERIOR ST STE B
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:
83864-1633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-265-3579
Provider Business Practice Location Address Fax Number:
208-204-0182
Provider Enumeration Date:
01/17/2024