Provider First Line Business Practice Location Address:
317 S RIVER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAILEY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83333-8426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-788-4900
Provider Business Practice Location Address Fax Number:
208-788-1122
Provider Enumeration Date:
07/03/2008