Provider First Line Business Practice Location Address:
160 MAIN AVE N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWIN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83301-6101
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-733-3024
Provider Business Practice Location Address Fax Number:
208-733-0929
Provider Enumeration Date:
12/11/2012