Provider First Line Business Practice Location Address:
3115 MEDICAL DRIVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CALDWELL
Provider Business Practice Location Address State Name:
ID
Provider Business Practice Location Address Postal Code:
83605-6972
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-453-8668
Provider Business Practice Location Address Fax Number:
208-453-8448
Provider Enumeration Date:
01/23/2006