Provider First Line Business Practice Location Address:
606 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KENDRICK
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83537-8353
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-289-3841
Provider Business Practice Location Address Fax Number:
208-289-3961
Provider Enumeration Date:
04/01/2021