Provider First Line Business Practice Location Address:
343 E MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEISER
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83672-2515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-414-3333
Provider Business Practice Location Address Fax Number:
208-414-3332
Provider Enumeration Date:
04/28/2014