Provider First Line Business Practice Location Address:
921 S 8TH AVE STOP 8173
Provider Second Line Business Practice Location Address:
SPORTS AND ORTHOPAEDIC CENTER
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83209-8173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-282-3408
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/13/2014