Provider First Line Business Practice Location Address:
1072 N LIBERTY STREET
Provider Second Line Business Practice Location Address:
STE 303
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-367-2800
Provider Business Practice Location Address Fax Number:
208-367-7111
Provider Enumeration Date:
03/23/2006