Provider First Line Business Practice Location Address:
408 N ALLUMBAUGH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83704-9209
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-323-9600
Provider Business Practice Location Address Fax Number:
208-323-9606
Provider Enumeration Date:
10/04/2013