Provider First Line Business Practice Location Address:
3237 S FEDERAL WAY
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:
83705-5215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-690-2401
Provider Business Practice Location Address Fax Number:
208-639-1836
Provider Enumeration Date:
03/24/2026