Provider First Line Business Practice Location Address:
415 W COLLINS RD
Provider Second Line Business Practice Location Address:
C/O BAF EMPLOYEE HEALTH CENTER
Provider Business Practice Location Address City Name:
BLACKFOOT
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83221-5642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
802-857-0400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/20/2015