Provider First Line Business Practice Location Address:
2001 HIGHWAY 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENDRICK
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83537-9739
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-289-4211
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/03/2007