Provider First Line Business Practice Location Address:
444 HOSPITAL WAY STE 801
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83201-2792
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-232-6214
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2006