Provider First Line Business Practice Location Address:
190 E BANNOCK ST
Provider Second Line Business Practice Location Address:
ST. LUKE'S INTERNAL MEDICINE
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83712-6241
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-647-3159
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/30/2009