Provider First Line Business Practice Location Address:
100 S IOWA AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRUITLAND
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83619-2644
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-249-5111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/29/2023