Provider First Line Business Practice Location Address:
1632 ADDISON AVE E
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:
83301-5358
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-886-3131
Provider Business Practice Location Address Fax Number:
208-886-3133
Provider Enumeration Date:
12/31/2014