Provider First Line Business Practice Location Address:
179 STUDENT HLTH CTR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REXBURG
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83460-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-496-9330
Provider Business Practice Location Address Fax Number:
208-496-9343
Provider Enumeration Date:
07/22/2006