Provider First Line Business Practice Location Address:
216 CLIFF ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IDAHO FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83402-3625
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-522-6244
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/31/2021