Provider First Line Business Mailing Address:
921 S. 8TH AVE., STOP 8088
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POCATELLO
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83209-8088
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-282-6000
Provider Business Mailing Address Fax Number:
208-282-4950