Provider First Line Business Practice Location Address:
525 PINE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POTLATCH
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83855
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-875-1212
Provider Business Practice Location Address Fax Number:
208-875-0859
Provider Enumeration Date:
11/13/2006