Provider First Line Business Practice Location Address:
1200 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:
83201-2708
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-232-2570
Provider Business Practice Location Address Fax Number:
208-233-6769
Provider Enumeration Date:
03/27/2015