Provider First Line Business Practice Location Address:
115 W IDAHO 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:
83672-1945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-878-3350
Provider Business Practice Location Address Fax Number:
208-878-3351
Provider Enumeration Date:
08/19/2009