Provider First Line Business Practice Location Address:
BYU - IDAHO
Provider Second Line Business Practice Location Address:
100 SHC
Provider Business Practice Location Address City Name:
REXBURG
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83460-2010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-496-1300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/27/2005