Provider First Line Business Practice Location Address:
239 IDAHO 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:
83211-1235
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-904-3496
Provider Business Practice Location Address Fax Number:
208-904-3514
Provider Enumeration Date:
05/26/2015