Provider First Line Business Practice Location Address:
560 N OREGON TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMERICAN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83211-1800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-226-5605
Provider Business Practice Location Address Fax Number:
208-226-7829
Provider Enumeration Date:
06/29/2005