Provider First Line Business Practice Location Address:
55 WEST 1ST NORTH
Provider Second Line Business Practice Location Address:
AMBULANCE HOUSE
Provider Business Practice Location Address City Name:
MALTA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-645-2498
Provider Business Practice Location Address Fax Number:
208-645-2300
Provider Enumeration Date:
02/12/2008