Provider First Line Business Practice Location Address:
301 E ASH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALDWELL
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83605-5282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-454-1222
Provider Business Practice Location Address Fax Number:
208-459-6947
Provider Enumeration Date:
08/16/2012