Provider First Line Business Practice Location Address:
35 NORTH 1ST EAST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DRIGGS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83422
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-351-3100
Provider Business Practice Location Address Fax Number:
208-354-5775
Provider Enumeration Date:
12/01/2006