Provider First Line Business Practice Location Address:
2985 CORTEZ AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IDAHO FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83404-7554
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-528-1000
Provider Business Practice Location Address Fax Number:
208-528-1900
Provider Enumeration Date:
07/16/2006