Provider First Line Business Practice Location Address:
601 E 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EMMETT
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83617-3111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-365-5971
Provider Business Practice Location Address Fax Number:
208-365-3413
Provider Enumeration Date:
01/24/2007