Provider First Line Business Practice Location Address:
650 ADDISON AVE W
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:
83301-5444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-737-2008
Provider Business Practice Location Address Fax Number:
208-737-2743
Provider Enumeration Date:
10/24/2006