Provider First Line Business Practice Location Address:
1607 HIGHWAY 2
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:
83864-1779
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-265-1705
Provider Business Practice Location Address Fax Number:
855-939-2028
Provider Enumeration Date:
10/21/2009