Provider First Line Business Practice Location Address:
1017 E YOUNG
Provider Second Line Business Practice Location Address:
HOPE WELLNESS CENTER
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83201-4406
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-235-4673
Provider Business Practice Location Address Fax Number:
208-441-4601
Provider Enumeration Date:
01/22/2009