Provider First Line Business Practice Location Address:
100 COURTHOUSE DR
Provider Second Line Business Practice Location Address:
STE. F
Provider Business Practice Location Address City Name:
SALMON
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83467-3919
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-756-3777
Provider Business Practice Location Address Fax Number:
208-756-3778
Provider Enumeration Date:
04/15/2008