Provider First Line Business Practice Location Address:
PORGY & PETUNIA'S PEDIATRIC THERAPY 111 E LILLIAN
Provider Second Line Business Practice Location Address:
SUITE 8
Provider Business Practice Location Address City Name:
SALMON
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-940-2170
Provider Business Practice Location Address Fax Number:
208-756-2354
Provider Enumeration Date:
09/11/2017