Provider First Line Business Practice Location Address:
1330 FILER AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWIN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83301-4119
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-734-4555
Provider Business Practice Location Address Fax Number:
208-734-3632
Provider Enumeration Date:
10/22/2009