Provider First Line Business Practice Location Address:
222 N. 2ND STREET
Provider Second Line Business Practice Location Address:
SUITE 307
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83702-6131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-344-1000
Provider Business Practice Location Address Fax Number:
208-344-1331
Provider Enumeration Date:
10/03/2007