Provider First Line Business Practice Location Address:
2167 VILLAGE PARK AVE
Provider Second Line Business Practice Location Address:
SUITE 200
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-735-3728
Provider Business Practice Location Address Fax Number:
208-735-3729
Provider Enumeration Date:
06/22/2010