Provider First Line Business Practice Location Address:
1 AIRPORT PLAZA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALMON
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83467-1232
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-756-4608
Provider Business Practice Location Address Fax Number:
208-156-8998
Provider Enumeration Date:
04/18/2007