Provider First Line Business Practice Location Address:
1133 CALL PL STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
POCATELLO
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83201-3076
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-232-1000
Provider Business Practice Location Address Fax Number:
208-232-1006
Provider Enumeration Date:
08/30/2006