Provider First Line Business Practice Location Address:
10 SOUTH 100 WEST
Provider Second Line Business Practice Location Address:
STE A WINWARD PHYSICAL THERAPY
Provider Business Practice Location Address City Name:
PRESTON
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83263-1244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-852-0116
Provider Business Practice Location Address Fax Number:
208-852-0116
Provider Enumeration Date:
10/03/2006