Provider First Line Business Practice Location Address:
1151 HOSPITAL WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83201-5091
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-564-2174
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/24/2014