NPI | LastName | FirstName | MidName | Organization | Mailing Address | City | State | Zip |
1205164126 | BALLANCE | PHILIP | ANDERS |   | 915 W EMMA AVE | COEUR D ALENE | ID | 838142531 |
1265000988 | CLINE | DARYL | SCOTT |   | 915 W EMMA AVE | COEUR D ALENE | ID | 838142531 |
1770029068 | MOORE | SHEENA |   |   | 915 W EMMA AVE | COEUR D ALENE | ID | 838142531 |