Provider First Line Business Practice Location Address:
7711 LOWER FORDS CREEK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OROFINO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83544-6389
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
541-773-8111
Provider Business Practice Location Address Fax Number:
888-814-4916
Provider Enumeration Date:
01/23/2019