Provider First Line Business Practice Location Address:
1151 HOSPITAL WAY, BLD D, STE 100
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:
83202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-277-3706
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/20/2013