Provider First Line Business Practice Location Address:
2827 POCATELLO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AMERICAN FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83211-5444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-358-3365
Provider Business Practice Location Address Fax Number:
385-331-5000
Provider Enumeration Date:
09/23/2022