Provider First Line Business Practice Location Address:
425 MAIN ST.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CASTLEFORD
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83321
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-358-0945
Provider Business Practice Location Address Fax Number:
208-733-9463
Provider Enumeration Date:
04/25/2024