Provider First Line Business Practice Location Address:
2022A 4TH AVE E
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TWIN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83301-7404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-733-0448
Provider Business Practice Location Address Fax Number:
208-733-0449
Provider Enumeration Date:
02/06/2007