Provider First Line Business Practice Location Address:
625 E ALAMEDA RD.
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
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-237-1567
Provider Business Practice Location Address Fax Number:
208-478-5097
Provider Enumeration Date:
02/05/2013