Provider First Line Business Practice Location Address:
701 LEWISTON ST.
Provider Second Line Business Practice Location Address:
ST. MARY'S HOSPITAL & CLINICS
Provider Business Practice Location Address City Name:
COTTONWOOD
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83522-0137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-962-3267
Provider Business Practice Location Address Fax Number:
208-962-2313
Provider Enumeration Date:
03/08/2007