Provider First Line Business Practice Location Address:
105 S. RAILROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COUNCIL
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83612-0739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
120-856-6778
Provider Business Practice Location Address Fax Number:
120-835-2477
Provider Enumeration Date:
01/17/2007