Provider First Line Business Practice Location Address:
1050 S PROGRESS AVE
Provider Second Line Business Practice Location Address:
SL/WINCO PHARMACY LOCKER
Provider Business Practice Location Address City Name:
MERIDIAN
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83642-3054
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-706-5252
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/17/2023