Provider First Line Business Practice Location Address:
1134 CHENEY DRIVE WEST
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:
208-644-7100
Provider Business Practice Location Address Fax Number:
208-644-7221
Provider Enumeration Date:
12/19/2016