Provider First Line Business Practice Location Address:
995 WASHINGTON ST S
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:
83301-5530
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-736-7060
Provider Business Practice Location Address Fax Number:
208-735-2865
Provider Enumeration Date:
04/06/2017