Provider First Line Business Practice Location Address:
6000 S QUAMASH WAY
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:
83716-5617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-383-0100
Provider Business Practice Location Address Fax Number:
208-321-5507
Provider Enumeration Date:
06/05/2007