Provider First Line Business Practice Location Address:
ISU PSYCHOLOGY CLINIC
Provider Second Line Business Practice Location Address:
IDAHO STATE UNIVERSITY, STOP 8112
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83209-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-282-2129
Provider Business Practice Location Address Fax Number:
208-282-5411
Provider Enumeration Date:
01/19/2007