Provider First Line Business Practice Location Address:
3001 E BADGER DR
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:
83687-4938
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-466-8193
Provider Business Practice Location Address Fax Number:
208-466-8182
Provider Enumeration Date:
06/04/2025