Provider First Line Business Practice Location Address:
118 9TH AVE N
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:
83301-6352
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-731-5260
Provider Business Practice Location Address Fax Number:
208-644-3213
Provider Enumeration Date:
11/21/2012