Provider First Line Business Practice Location Address:
815 N COLLEGE RD
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:
83301-3484
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-814-9100
Provider Business Practice Location Address Fax Number:
208-814-9903
Provider Enumeration Date:
11/18/2005