Provider First Line Business Practice Location Address:
510 ROOSEVELT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMERICAN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83211-1362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-226-3200
Provider Business Practice Location Address Fax Number:
208-226-3218
Provider Enumeration Date:
09/15/2006