Provider First Line Business Practice Location Address:
500 BOYD ST W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURTAUGH
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83344-5011
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-432-5451
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2010