Provider First Line Business Practice Location Address:
140 HANSEN ST E
Provider Second Line Business Practice Location Address:
STE 9
Provider Business Practice Location Address City Name:
TWIN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83301
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-733-7941
Provider Business Practice Location Address Fax Number:
208-733-5415
Provider Enumeration Date:
10/24/2006