Provider First Line Business Practice Location Address:
1201 FALLS AVE EAST
Provider Second Line Business Practice Location Address:
SUITE 36
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-734-6700
Provider Business Practice Location Address Fax Number:
208-734-6795
Provider Enumeration Date:
03/19/2007