Provider First Line Business Practice Location Address:
85 S 5TH W
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAVA HOT SPRINGS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-776-5202
Provider Business Practice Location Address Fax Number:
844-492-9775
Provider Enumeration Date:
10/02/2019