Provider First Line Business Practice Location Address:
813 STILSON RD. SUITE B
Provider Second Line Business Practice Location Address:
MILLENNIUM FAMILY DENTAL BOISE LLC
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-342-4644
Provider Business Practice Location Address Fax Number:
208-888-2094
Provider Enumeration Date:
10/31/2006