Provider First Line Business Practice Location Address:
3446 N 4500 E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURTAUGH
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83344-5014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-432-2947
Provider Business Practice Location Address Fax Number:
208-432-2947
Provider Enumeration Date:
04/25/2026