Provider First Line Business Practice Location Address:
318 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KAMIAH
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83536
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-935-2301
Provider Business Practice Location Address Fax Number:
208-935-2477
Provider Enumeration Date:
02/04/2026