Provider First Line Business Practice Location Address:
47390 HIGHWAY 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOPE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83836-9647
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-265-8333
Provider Business Practice Location Address Fax Number:
208-263-1394
Provider Enumeration Date:
08/12/2006