Provider First Line Business Practice Location Address:
190 WEST MAIN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KUNA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-922-9001
Provider Business Practice Location Address Fax Number:
208-922-3778
Provider Enumeration Date:
10/20/2006