Provider First Line Business Practice Location Address:
2311 PARKE AVE., STE. 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURLEY
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83350
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-878-3350
Provider Business Practice Location Address Fax Number:
208-878-3351
Provider Enumeration Date:
07/06/2011