Provider First Line Business Practice Location Address:
844 WASHINGTON ST N STE 400
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:
83301-3874
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-734-0000
Provider Business Practice Location Address Fax Number:
208-735-5053
Provider Enumeration Date:
09/27/2006