Provider First Line Business Practice Location Address:
25431 HWY 93
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHALLIS, IDAHO 83226
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83226-8322
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-879-2267
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/05/2014