Provider First Line Business Practice Location Address:
65 AMERICAN RIVER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ELK CITY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83525-0206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-842-2626
Provider Business Practice Location Address Fax Number:
208-842-2626
Provider Enumeration Date:
09/11/2006