Provider First Line Business Practice Location Address:
1412 W WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83702-5038
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-336-1900
Provider Business Practice Location Address Fax Number:
208-890-6427
Provider Enumeration Date:
11/09/2006