Provider First Line Business Practice Location Address:
1155 POCATELLO CREEK RD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83201
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-238-1100
Provider Business Practice Location Address Fax Number:
208-233-4933
Provider Enumeration Date:
04/03/2007