Provider First Line Business Practice Location Address:
1109 W. MYRTLE ST. SUITE 200
Provider Second Line Business Practice Location Address:
ST. LUKE'S HOSPITAL SYSTEM
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-308-4075
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/25/2009