Provider First Line Business Practice Location Address:
1000 POCATELLO CREEK ROAD
Provider Second Line Business Practice Location Address:
FOOTHILL PLAZA
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83201-2999
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-234-0757
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2006