Provider First Line Business Practice Location Address:
524 TYHEE AVE
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:
83211-1224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-226-2411
Provider Business Practice Location Address Fax Number:
208-226-5124
Provider Enumeration Date:
10/05/2006