Provider First Line Business Practice Location Address:
718 SHOSHONE ST 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:
83301-6111
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-969-1112
Provider Business Practice Location Address Fax Number:
208-696-0445
Provider Enumeration Date:
02/09/2021