Provider First Line Business Practice Location Address:
12249 W MCMILLAN RD
Provider Second Line Business Practice Location Address:
CONTENNTAL DENTAL CENTER
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83713-0555
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-322-0024
Provider Business Practice Location Address Fax Number:
208-375-5721
Provider Enumeration Date:
09/28/2006