Provider First Line Business Practice Location Address:
IDAHO STATE UNIVERSITY
Provider Second Line Business Practice Location Address:
DEPARTMENT OF PSYCHOLOGY, STOP 8112
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83209-8112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-282-2142
Provider Business Practice Location Address Fax Number:
208-282-4832
Provider Enumeration Date:
02/27/2008