Provider First Line Business Practice Location Address:
1007 W 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FILER
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83328-5335
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-404-9500
Provider Business Practice Location Address Fax Number:
208-326-5187
Provider Enumeration Date:
05/14/2007