Provider First Line Business Practice Location Address:
637 E DEER FLAT RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KUNA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83634-3444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-955-0200
Provider Business Practice Location Address Fax Number:
208-922-2178
Provider Enumeration Date:
12/13/2005