Provider First Line Business Practice Location Address:
16017 IDAHO CENTER BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NAMPA
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83687-5010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-461-4460
Provider Business Practice Location Address Fax Number:
208-461-4326
Provider Enumeration Date:
04/02/2007