Provider First Line Business Practice Location Address:
223 N. 6TH STREET, SUITE 100
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:
83702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-724-8666
Provider Business Practice Location Address Fax Number:
208-908-0058
Provider Enumeration Date:
01/20/2010