Provider First Line Business Practice Location Address:
2404 S ORCHARD ST
Provider Second Line Business Practice Location Address:
STE 800
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83705-6725
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-345-2222
Provider Business Practice Location Address Fax Number:
208-620-2215
Provider Enumeration Date:
12/22/2010