Provider First Line Business Practice Location Address:
2770 CORTEZ AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IDAHO FALLS
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83404-7590
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-522-4000
Provider Business Practice Location Address Fax Number:
208-528-4242
Provider Enumeration Date:
02/06/2025