Provider First Line Business Practice Location Address:
180 S HOLMES AVE
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:
83401-3945
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-525-8700
Provider Business Practice Location Address Fax Number:
208-525-8636
Provider Enumeration Date:
04/12/2024