Provider First Line Business Practice Location Address:
6657 N GLENWOOD ST
Provider Second Line Business Practice Location Address:
WATER'S EDGE DENTAL
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-375-0572
Provider Business Practice Location Address Fax Number:
208-375-1658
Provider Enumeration Date:
03/08/2007