Provider First Line Business Practice Location Address:
5019 N SAWYER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GARDEN CITY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-375-1600
Provider Business Practice Location Address Fax Number:
208-375-1606
Provider Enumeration Date:
09/23/2016