Provider First Line Business Practice Location Address:
173 E 4TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KUNA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83634-2103
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-922-4400
Provider Business Practice Location Address Fax Number:
208-922-4499
Provider Enumeration Date:
10/10/2005