Provider First Line Business Practice Location Address:
5216 E. CLEVELAND BLVD
Provider Second Line Business Practice Location Address:
STE G
Provider Business Practice Location Address City Name:
CALDWELL
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-454-5500
Provider Business Practice Location Address Fax Number:
208-454-8877
Provider Enumeration Date:
12/16/2008