Provider First Line Business Practice Location Address:
6290 E LEMHI CT
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:
83687-9177
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-509-9400
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2023