Provider First Line Business Practice Location Address:
551 HUCKLEBERRY BUTTE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OROFINO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83544-5083
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-827-6093
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2023