Provider First Line Business Mailing Address:
1151 HOSPITAL WAY, BLDG A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
POCATELLO
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83201-5091
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
208-232-6616
Provider Business Mailing Address Fax Number:
208-232-6618