Provider First Line Business Practice Location Address:
190 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KUNA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-962-1849
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/19/2019