Provider First Line Business Practice Location Address:
459 LOCUST ST N SUITE 108
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-539-2226
Provider Business Practice Location Address Fax Number:
208-481-8489
Provider Enumeration Date:
02/08/2012