Provider First Line Business Practice Location Address:
800 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALMON
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83467
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-756-8708
Provider Business Practice Location Address Fax Number:
208-756-8707
Provider Enumeration Date:
08/20/2006