Provider First Line Business Practice Location Address:
1800 MIDLAND 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:
83651-7016
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-340-0292
Provider Business Practice Location Address Fax Number:
280-960-1775
Provider Enumeration Date:
10/11/2005