Provider First Line Business Practice Location Address:
1502 W FRANKLIN ST
Provider Second Line Business Practice Location Address:
NORTH END WELLNESS
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83702-4028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-371-3671
Provider Business Practice Location Address Fax Number:
208-344-3059
Provider Enumeration Date:
06/30/2009