Provider First Line Business Practice Location Address:
94 N COMMERCIAL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GLENNS FERRY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83623-2342
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-366-1200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/12/2025