Provider First Line Business Practice Location Address:
2798 ARTHUR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMERICAN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83211-5413
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-226-1751
Provider Business Practice Location Address Fax Number:
208-226-1767
Provider Enumeration Date:
01/16/2007