Provider First Line Business Practice Location Address:
117 N HILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KELLOGG
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83837-2224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-682-2127
Provider Business Practice Location Address Fax Number:
208-682-3900
Provider Enumeration Date:
10/26/2006