Provider First Line Business Practice Location Address:
2647 KIMBERLY RD STE 2
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:
83301-7976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-734-1281
Provider Business Practice Location Address Fax Number:
208-933-4435
Provider Enumeration Date:
03/05/2007