Provider First Line Business Practice Location Address:
16700 N MARKET PLACE 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:
83687-7909
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-465-3824
Provider Business Practice Location Address Fax Number:
208-465-3825
Provider Enumeration Date:
03/24/2015