Provider First Line Business Practice Location Address:
3728 N 3700 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KIMBERLY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83341-5087
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-420-4460
Provider Business Practice Location Address Fax Number:
208-423-9007
Provider Enumeration Date:
11/17/2011