Provider First Line Business Practice Location Address:
30544 HIGHWAY 200 STE 201
Provider Second Line Business Practice Location Address:
PEND OREILLE SURGERY CENTER
Provider Business Practice Location Address City Name:
PONDERAY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83852-5005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-265-8194
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/14/2009