Provider First Line Business Practice Location Address:
1431 WASHINGTON ST S
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWIN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83301-8008
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-731-3398
Provider Business Practice Location Address Fax Number:
208-735-8390
Provider Enumeration Date:
08/07/2013