Provider First Line Business Practice Location Address:
775 POLE LINE RD W STE 212
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:
83301-5820
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-814-8400
Provider Business Practice Location Address Fax Number:
208-734-3045
Provider Enumeration Date:
07/22/2020