Provider First Line Business Practice Location Address:
1800 N 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:
83651-1747
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
208-615-1313
Provider Business Practice Location Address Fax Number:
208-960-1775
Provider Enumeration Date:
04/17/2024