Provider First Line Business Practice Location Address:
311 ALLUMBAUGH ST
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:
83704-9208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-375-6402
Provider Business Practice Location Address Fax Number:
208-323-1850
Provider Enumeration Date:
09/05/2007