Provider First Line Business Practice Location Address:
801 POLE LINE ROAD WEST
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:
83301-5799
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-814-1000
Provider Business Practice Location Address Fax Number:
208-814-0948
Provider Enumeration Date:
07/18/2011