Provider First Line Business Practice Location Address:
3543A HIGHWAY 93
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWIN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83301-0465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-731-7832
Provider Business Practice Location Address Fax Number:
208-734-2613
Provider Enumeration Date:
03/30/2007