Provider First Line Business Practice Location Address:
1406 E FRANKLIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOISE
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83712-7404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-331-1936
Provider Business Practice Location Address Fax Number:
208-331-1937
Provider Enumeration Date:
12/11/2006