Provider First Line Business Practice Location Address:
409 CHURCH ST
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:
83864-1346
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-906-2525
Provider Business Practice Location Address Fax Number:
208-906-2527
Provider Enumeration Date:
04/08/2009