Provider First Line Business Practice Location Address:
999 N. CURTIS ROAD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-373-1200
Provider Business Practice Location Address Fax Number:
208-373-1216
Provider Enumeration Date:
10/03/2006