Provider First Line Business Practice Location Address:
201 NORTH IDAHO STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARCO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83213
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-527-3046
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/17/2007