Provider First Line Business Practice Location Address:
703 AMERICANA BLVD., SUITE 105
Provider Second Line Business Practice Location Address:
ST. LUKE'S PSYCHIATRIC WELLNESS SERVICES
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83702-0550
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-706-6375
Provider Business Practice Location Address Fax Number:
208-706-6395
Provider Enumeration Date:
11/20/2008