Provider First Line Business Practice Location Address:
3000 LEMHI RD
Provider Second Line Business Practice Location Address:
PO BOX 21
Provider Business Practice Location Address City Name:
LEMHI
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83465-0021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
385-433-1835
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2025